G Model RESUS-5956; No. of Pages 5

ARTICLE IN PRESS Resuscitation xxx (2014) xxx–xxx

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Resuscitation journal homepage: www.elsevier.com/locate/resuscitation

Clinical Paper

Are APLS formulae for estimating weight appropriate for use in children admitted to PICU?夽,夽夽 Christopher Flannigan a,∗ , Thomas W. Bourke b , Ashey Sproule b , Mike Stevenson c , Mark Terris d a

Paediatric Intensive Care, Birmingham Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom Paediatrics, Royal Belfast Hospital for Sick Children, 180–184 Falls Rd, Belfast BT12 6BE, United Kingdom c Department of Epidemiology and Public Health, Queen’s University, Belfast BT9 5EE, United Kingdom d Paediatric Intensive Care, Royal Belfast Hospital for Sick Children, 180–184 Falls Rd, Belfast BT12 6BE, United Kingdom b

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Article history: Received 11 November 2013 Received in revised form 18 March 2014 Accepted 24 March 2014 Keywords: Body weight Intensive care units, Paediatric Child Emergencies Great Britain Electronic Prescribing

a b s t r a c t Aim: To determine if the revised APLS UK formulae for estimating weight are appropriate for use in the paediatric intensive care population in the United Kingdom. Methods: A retrospective observational study involving 10,081 children (5622 male, 4459 female) between the age of term corrected and 15 years, who were admitted to Paediatric Intensive Care Units in the United Kingdom over a five year period between 2006 and 2010. Mean weight was calculated using retrospective data supplied by the ‘Paediatric Intensive Care Audit Network’ and this was compared to the estimated weight generated using age appropriate APLS UK formulae. Results: The formula ‘Weight = (0.5 × age in months) + 4’ significantly overestimates the mean weight of children under 1 year admitted to PICU by between 10% and 25.4%. While the formula ‘Weight = (2 × age in years) + 8’ provides an accurate estimate for 1-year-olds, it significantly underestimates the mean weight of 2–5 year olds by between 2.8% and 4.9%. The formula ‘Weight = (3 × age in years) + 7’ significantly overestimates the mean weight of 6–11 year olds by between 8.6% and 20.7%. Simple linear regression was used to produce novel formulae for the prediction of the mean weight specifically for the PICU population. Conclusions: The APLS UK formulae are not appropriate for estimating the weight of children admitted to PICU in the United Kingdom. Relying on mean weight alone will result in significant error as the standard deviation for all age groups are wide. © 2014 Elsevier Ireland Ltd. All rights reserved.

1. Introduction The gold standard for prescribing therapies to children admitted to Paediatric Intensive Care (PICU) requires accurate measurement of the patient’s weight. Invariably preparation for a PICU admission starts before the patient arrives when a weight is usually unavailable. When the patient arrives an accurate weight may not be obtainable immediately because of instability and on-going

夽 A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2014.03.313 夽夽 Institution where the work was performed: Paediatric Intensive Care, Royal Belfast Hospital for Sick Children, 180–184 Falls Rd, Belfast BT12 6BE, United Kingdom. ∗ Corresponding author. E-mail address: christopher.fl[email protected] (C. Flannigan).

resuscitation. An accurate tool to aid the critical care team estimate the weight of these children would be a valuable clinical tool. Guessing the patients weight is inaccurate1 and parental history or a Broselow tape, while more accurate,2,3 are of little use before the patient arrives. The initial validation of the traditional Advanced Paediatric Life Support (ALPS) formula ‘Weight in kg = (age in years + 4) × 2’4 is not documented in the literature and several recent studies have shown it to be inaccurate.5–8 More recently the APLS UK has modified its recommendations to include the following three formulae for different age groups9 : Age

Are APLS formulae for estimating weight appropriate for use in children admitted to PICU?

To determine if the revised APLS UK formulae for estimating weight are appropriate for use in the paediatric intensive care population in the United K...
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