Columns, Commentary, Patient Care

Tale of the Tape: How Accurate is the Broselow Tape for Weight Estimation and Drug Dosing?

Issue 4 and Volume 43.

How accurate is the Broselow tape?

The Research

Wells M, Goldstein LN, Bentley A, et al. The accuracy of the Broselow tape as a weight estimation tool and a drug-dosing guide: A systematic review and meta-analysis. Resuscitation. 2017;121:9–33.

The Science

In this study, the authors wanted to address questions regarding the Broselow tape’s accuracy in estimating pediatric weight, as well as examine its impact on drug calculations. They examined 1,318 studies and found 118 that met eligibility criteria for statistical review.

Eighty-four studies addressed weight estimation, of which 58 met criteria for review based on the strength of the quantitative data. The studies spanned from the 1988 article that introduced the Broselow tape to the latest articles in 2017. Their findings included the following:

>> The Broselow tape was significantly more accurate than provider guesses and age-based formulas;

>> Most studies showed it to be less accurate than parental guesses;

>> It was most accurate for children between 10 and 25 kg;

>> It resulted in just over 50% of children having a weight estimation within 10% of their actual body weight;

>> It consistently performed poorly when compared to other techniques that combine both length and body habitus, such as the Mercy method, the PAWPER tape, and the Wozniak method;

>> It consistently underestimates the weights of children in mid- to high-income counties, while overestimating the weights of children in low-income countries; and

>> Because the tape requires calculations for drug dosing, errors > 20% occur in up to 50% drug calculations.

Their conclusion? “The Broselow tape lacked sufficient accuracy as a weight estimation and drug-dosing tool when compared to other available techniques. In addition, the Broselow tape contains insufficient drug dosing information to function as a complete resuscitation aid without additional material. The frequent rate of incorrect usage of the tape indicated that appropriate training with the tape is mandatory to reduce errors.”

Doc Wesley Comments

I remember my first PALS course in the late 1980s, when I was introduced to the Broselow tape. I thought it was the greatest invention to aid me in caring for the sickest kids which, like everyone, ratchets up my pucker factor.

But it appears this tool has become outdated. It bases its estimations from data collected from the National Health and Nutrition Examination Survey. Although this is an important project by the Centers for Disease Control and Prevention, it may not take into account the extreme variability of America’s melting pot population.

America has an increasing population of immigrants from India, Somalia, South Africa and other low-income countries where body weight is significantly lower than their overweight American cohorts. Chronically ill children are usually underweight and the use of the Broselow tape may represent an unacceptable risk for resuscitation drug overdosing.

Recently, a finger-counting technique called the Handtevy method has been found to be more accurate in weight estimation. Additionally, the Handtevy method results in faster time to medication administration through reduction in drug dose calculations.

I’ve been using the Handtevy method in my service for the past three years, and can attest to its ability to reduce the anxiety of pediatric resuscitation. And, in full transparency, I have no financial relationship to Handtevy.

Medic Wesley Comments

I’m fortunate to have the ability to review new products and updates to past products. I’m familiar with Broselow from my practice in EMS, but haven’t had the opportunity to work with the Handtevy method.

As Doc stated, pediatric calls are tough. The heat is on when it comes to caring for these little ones. The last thing a provider wants to do is to look up a medication, calculate the correct dose and then convert milligrams to milliliters—all while the clock is ticking. Breaking out the Broselow tape every six months for a skills evaluation isn’t enough.

A large responsibility for the provider’s understanding of and comfort with the use of any of the length-based systems falls on the professionalism of the provider. It requires regular familiarity to become comfortable and knowledgeable in their use.

Stepping down from my soapbox on the need for individual accountability in training and education, I’ll move on to the facts of the Broselow and this study.

In 2017, Broselow revised the tape with conversions to milliliters for medication, taking away the need to convert doses in our heads. That should correct some errors.

Another change allows for ”habitus” alteration to weights when necessary, which should address questions related to whether the child is over or under weight.

I look forward to published data to determine if these changes address the dosing errors and weight estimation this study has highlighted.