A correlation analysis of Broselow™ Pediatric Emergency Tape-determined pediatric weight with actual pediatric weight in India

BACKGROUND: The Broselow™ Pediatric Emergency Tape indicates standardized, pre-calculated medication doses, dose delivery volumes, and equipment sizes using color-coded zones based on height-weight correlations. The present study attempted to provide more evidence on the effectiveness of the Broselow™ Pediatric Emergency Tape by comparing the tape-estimated weights with actual weights. We hypothesized that the Broselow™ Pediatric Emergency Tape would overestimate weights in Indian children aged<10 years, leading to inaccurate dosing and equipment sizing in the emergency setting.METHODS: This prospective study of pediatric patients aged <10 years who were divided into three groups based on actual body weight: <10 kg, 10-18 kg, and >18 kg. We calculated the percentage difference between the Broselow-predicted weight and the measured weight as a measure of tape bias. Concordant results were those with a mean percent difference within 3%. Standard deviation was measured to determine precision. Accuracy was determined as color-coded zone prediction and measured weight concordance, including the percentage overestimation by 1-2 zones.RESULTS: The male-to-female ratio of the patients was 1.3:1. Total agreement between color-coding was 63.18% (κ=0.582). The Broselow™ color-coded zone agreement was 74.8% in the <10 kg group, 61.24% in the 10-18 kg group, and 53.42% in the >18 kg group.CONCLUSIONS: The Broselow™ Pediatric Emergency Tape showed good evidence for being more reliable in children of the <10 kg and 10-18 kg groups. However, as pediatric weight increased, predictive reliability decreased. This raises concerns over the use of the Broselow™ Pediatric Emergency Tape in Indian children because body weight was overestimated in those weighing >18 kg.     

Comparison of Broselow tape measurements versus physician estimations of pediatric weights

Objective

We sought to determine the agreement of physician estimates compared with Broselow tape measurements in accurately determining children's weights. Our secondary objective was to evaluate whether physician adjustment of the Broselow tape weight measurement is a better estimate of pediatric weight compared with either method alone.

Methods

This cross-sectional study was conducted in the emergency department (ED) of a tertiary children's hospital. Children between the ages of 0 and 14 years consecutively registered in the pediatric ED were eligible for enrollment. Height, weight, body mass index, and Broselow tape measurement were obtained for all subjects. Blinded ED physicians provided estimates for weight and body habitus for enrolled subjects. Physicians next were given the Broselow weight measurement and then submitted a second, amended estimate (hybrid). Percentage differences were used to analyze the discrepancy between estimates and actual weight. Specifically examined were the proportion of estimates that fell within 10% of the patients' actual body weights.

Results

A total of 372 subjects met the inclusion criteria. Mean age was 45.7 months, mean body mass index was 17.4, mean weight was 16.8 kg, and 39 participants (18.1%) met the definition for obese. Broselow estimates were within 10% of actual weight 63% of the time, physician estimates were within 10% of the actual weight 43% of the time and hybrid estimates 55% of the time. Based on average mean percent error, compared with actual weight, Broselow differed by 10.8% (95% confidence interval [CI], 9.7-12), hybrid estimate by 11.3% (95% CI, 10.3-12.2), and physician estimate by 16.2% (95% CI, 14.7-17.7). The Broselow tape was significantly worse than physician estimate for obese patients: 26.4% (95% CI, 19.7-33.1) versus 16.0% (95% CI, 12.3-19.8).

Conclusion

The Broselow tape generally has greater agreement with actual weight than physician visual estimation, except for obese children. Physician adjustment of the Broselow measurement also proved to be comparable to the Broselow tape.     

Can the Broselow Tape Be Used to Estimate Weight and Endotracheal Tube Size in Korean Children?

Background The Broselow pediatric emergency tape (BT) was developed to provide a length-based estimate of body weight and equipment size during resuscitation.
Objectives To conduct a validation study on the use of the BT in Korean children.
Methods Anesthesia records from children were retrospectively reviewed. The measured weights of the subjects were compared with the BT weight estimates by using Bland-Altman analysis. The accuracy of the BT and age-based formula in predicting the endotracheal tube (ETT) size were also compared. The authors drew a receiver operating characteristics (ROC) curve to evaluate the cutoff height that would be acceptable for the application of BT without error in Korean children.
Results A total of 665 children (mean [± SD] age, 5.1 [± 3.3] years, 61.8% male) were enrolled. The average measured weight of the Korean children was 1.54 kg heavier than the BT estimates (95% CI = 1.24 to 1.85 kg). The BT estimates showed better agreement with the actually used ETT sizes than did the age-based formula estimates (86.9% vs. 34.9%, p < 0.001). The cutoff height of the ROC curve was 127.15 cm. When the BT was used in children who were shorter than the cutoff height, 98.8% of the enrolled children's estimated weights were within the limits of agreement.
Conclusions The BT can be used in Korean children as a helpful adjunct during resuscitation to estimate the weight and ETT size.     

A comparison of actual to estimated weights in Australian children attending a tertiary children's’ hospital,using the original and updated APLS,Luscombe and Owens,Best Guess formulae and the Broselow tape

Introduction

During paediatric resuscitation it is essential to be able to estimate the child's weight as it determines drug doses and equipment sizes. Age and length-based estimations exist, with age-based estimations being especially useful in the preparation phase and the length-based Broselow tape having weight-based drug doses and equipment already assigned via a colour code system. The aim of this study was to compare the actual recorded weights of Australian children to the predicted weights using the original and updated APLS, Luscombe and Owens and Best Guess formulae and the Broselow tape.

Method

A retrospective observational study of children attending an Australian tertiary children's hospital.

Results

From 49,565 patients extracted from the database, 37,114 children with age and weight and 37,091 children with age and height recorded were included in the analysis. Best Guess was the most accurate, with the smallest overall mean difference 0.86 kg. For <1 year old, Broselow tape was the most accurate (mean difference −0.43 kg), Best Guess was the most accurate for ages 1–5 years and 11–14 years (mean difference 0.27 and 0.20 kg respectively), and the updated APLS formula was the most accurate for 6–10 year-old (mean difference 0.42 kg). The Broselow tape was able to only classify 48.9% of children into the correct weight colour band.

Conclusions

For an age-based weight estimation, in infants less than one year the new APLS formula is the most accurate and over one year the Best Guess formulae should be used.     

The PAWPER tape: A new concept tape-based device that increases the accuracy of weight estimation in children through the inclusion of a modifier based on body habitus

Aims

Weight estimations in children, which are required when actual weight cannot be measured, are often very inaccurate because of variations in body habitus not accounted for in the estimating methodology. This study was conducted to evaluate the accuracy of the PAWPER tape, a new two-step weight-estimation tape device which employs a length-based habitus-modified weight estimation system.

Methods

This was a prospective study in the Emergency Departments of two hospitals in Johannesburg, South Africa on a population of children aged from 1 month to 12 years. Each child had their weight estimated by both the Broselow tape and the PAWPER tape. These weight estimates were then compared against measured weight to determine the bias and precision of the estimation techniques.

Results

The PAWPER tape performed well, and better than the Broselow tape in every analysis performed. The mean percentage error was −3.8% vs 0% and the root mean squared percentage error was 9.1% vs 4.5% for the Broselow tape and PAWPER tape, respectively (p < 0.0001). The Broselow tape predicted weight to within 10% of actual weight in 63.6% of children and the PAWPER tape in 89.2% (p < 0.0001). The difference between the performances of the Broselow tape and PAWPER tape was most pronounced in children >20 kg, and in children above or below average weight-for-length.

Conclusions

The PAWPER tape has been shown to be a simple and reliable method of weight estimation in children and infants. The inclusion of an appraisal of body habitus in the methodology considerably improved the accuracy of weight estimation.     

Obesity in the pediatric headache population: a multicenter study

Objective.— To examine the prevalence of obesity, the relationship between weight compared with headache frequency and disability, and effect of weight change on headache outcomes within a pediatric headache population.
Background.— Headache and obesity are both common conditions in children and adults. Research in adults has suggested a relationship between the 2 conditions. This relationship has not yet been explored within a pediatric population. The effect of obesity and weight change on headache outcomes may have important implications for clinical care.
Method.— Data on height, weight, age, and gender, as well as headache frequency and disability, were collected on 913 consecutive patients at 7 pediatric headache centers, the body mass index (BMI) calculated and the BMI percentile determined. The same data were collected on patients seen at 3- (n = 213) and 6-month (n = 174) follow-up for comparative analysis.
Results.— The prevalence of overweight patients at initial visit did not significantly differ from the general pediatric population. BMI percentile was significantly correlated with headache frequency and disability at initial visit, although the correlations were relatively small. For children who were obese or at risk for overweight as initial visit, change in BMI was significantly positively correlated with change in headache frequency at 3- and 6-month follow-up.
Conclusions.— Obesity is associated with headache frequency and disability in the pediatric headache population. For children who are overweight, weight loss can contribute to a reduction in headaches over time. Clinicians should consider child weight status in providing care for pediatric headache.     

Estimating the weight of children in Nepal by Broselow,PAWPER XL and Mercy method

BACKGROUND: Resuscitation of a critically-ill child requires an accurate weight for fluids and medication dosing; however, weighing children on a scale while critically ill is not always practical. The objective of this study is to determine the accuracy of three different weight estimation methods (Broselow, PAWPER XL and Mercy tape) of children presenting to Patan Hospital, Nepal.METHODS: This was a prospective, cross-sectional study that included children presenting to the emergency department and under-fourteen outpatient clinic at Patan Hospital. Measured weight was compared to estimated weight of Broselow, PAWPER XL, and Mercy tapes. The mean percentage error and percentage of estimated weights that were within 10% (PW10) and 20% (PW20) of actual weight were calculated. Acceptable accuracy was determined as a PW10>70% and PW20>95%. A Bland-Altman analysis was done to determine agreement between each weight estimation method and actual weight.RESULTS: The study included 813 children. The mean age was 4.2 years (ranging from 4 days to 14 years) with 60% male. The mean percentage error (MPE) for Broselow, PAWPER XL and Mercy were -1.0% (SD 11.8), 0.7% (10.5) and 4.2% (11.9) respectively. The predicted weight within 10% was highest for the PAWPER XL (71.5%) followed by Broselow (63.2%) and Mercy (58.1%). The predicted weight within 20% of actual weight was 95.2%, 91.5% and 91.3% for PAWPER XL, Broselow and Mercy respectively.CONCLUSION: The PAWPER XL tape was the only method found to be accurate in estimating the weight of Nepalese children.     

Comparison of Errors Using Two Length-Based Tape Systems for Prehospital Care in Children

Background: The use of a length/weight-based tape (LBT) for equipment size and drug dosing for pediatric patients is recommended in a joint statement by multiple national organizations. A new system, known as Handtevy?, allows for rapid determination of critical drug doses without performing calculations. Objective: To compare two LBT systems for dosing errors and time to medication administration in simulated prehospital scenarios. Methods: This was a prospective randomized trial comparing the Broselow Pediatric Emergency Tape? (Broselow) and Handtevy LBT? (Handtevy). Paramedics performed 2 pediatric simulations: cardiac arrest with epinephrine administration and hypoglycemia mandating dextrose. Each scenario was repeated utilizing both systems with a 1-year-old and 5-year-old size manikin. Facilitators recorded identified errors and time points of critical actions including time to medication. Results: We enrolled 80 paramedics, performing 320 simulations. For Dextrose, there were significantly more errors with Broselow (63.8%) compared to Handtevy (13.8%) and time to administration was longer with the Broselow system (220 seconds vs. 173 seconds). For epinephrine, the LBTs were similar in overall error rate (Broselow 21.3% vs. Handtevy 16.3%) and time to administration (89 vs. 91 seconds). Cognitive errors were more frequent when using the Broselow compared to Handtevy, particularly with dextrose administration. The frequency of procedural errors was similar between the two LBT systems. Conclusion: In simulated prehospital scenarios, use of the Handtevy LBT system resulted in fewer errors for dextrose administration compared to the Broselow LBT, with similar time to administration and accuracy of epinephrine administration.     

Are methods used to estimate weight in children accurate?

Objective: The exact weight of a child undergoing resuscitation is usually not known. Several methods to estimate a child’s weight have been proposed. We evaluated six of these methods to determine their accuracy and clinical usefulness across a range of weights and ages. Method: Children attending a tertiary paediatric emergency department on 30 non‐consecutive days were weighed, a length or height was obtained and an estimation of body habitus (slim, average or heavy) made by a single investigator, Karen Black (KB). All children less than 145 cm were also measured using the Broselow tape. Six methods of weight estimation were employed and the calculated weight compared to the true weight. The weight estimation methods evaluated were the advanced paediatric life support (APLS) method, Broselow tape, devised weight estimation method (DWEM), Oakley table, Traub–Johnson and the Traub–Kichen methods. Results: Four hundred and ninety‐five children were included in the study. Children were evenly distributed among the weight groups of less than 10 kg, 10–25 kg, 25–40 kg and over 40 kg. The methods with the best overall performance were the devised weight estimation method and Broselow tape although the latter has a length limitation of 145 cm. The other methods performed well in the middle two weight groups but poorly outside these groups. Conclusions: The most accurate methods of weight estimation in children are the Broselow tape and the devised weight estimation method . We recommend the use of either of these methods in emergency situations where direct weighing is not possible.     

Acute Ethanol Coingestion Confers a Lower Risk of Hepatotoxicity after Deliberate Acetaminophen Overdose

Objectives:  Little is known about the clinical significance of acute ethanol coingestion around the time of acetaminophen (paracetamol) overdose. This study prospectively examined the effect of acute ethanol coingestion on risk of hepatotoxicity among patients admitted to hospital for N -acetylcysteine (NAC) therapy after deliberate acetaminophen overdose.
Methods:  This was a prospective observational study and included sequential patients who presented within 24 hours of acute acetaminophen ingestion and required NAC therapy. Significant hepatotoxicity was defined by alanine transaminase > 1,000 U/L or the international normalized ratio > 1.3 after a standardized intravenous administration of 300 mg/kg NAC.
Results:  There were 362 patients, including 178 (49.2%) who coingested ethanol acutely. The prevalence of hepatotoxicity was 5.1% (95% CI = 2.6% to 9.5%) in those who ingested ethanol, compared to 15.2% (95% CI = 10.7% to 21.2%) in those who did not (p = 0.0027 by chi-square proportional test). Acute ethanol intake conferred a lower risk of hepatotoxicity in patients who had acetaminophen concentrations above or below the "200-line" and was independent of the interval between ingestion and assessment.
Conclusions:  Acute ethanol intake is associated with a lower risk of hepatotoxicity after acetaminophen overdose. This apparent protective effect cannot be explained solely by lower exposure to acetaminophen in this group, nor differences in the interval between ingestion and initiation of treatment. Further work is required to establish mechanisms by which ethanol might confer protection against hepatotoxicity, so as to identify novel strategies for reducing risk after acute acetaminophen ingestion.     

Simple standing test predicts and water ingestion prevents vasovagal reaction in the high-risk blood donors

BACKGROUND: One of the serious complications of blood donation is vasovagal reaction (VVR) with syncope. This study was performed to determine if the measurement of hemodynamic responses to standing before blood collection (BC) was useful to identify the high-risk donors for VVR and also examined the effect of 300 mL of water ingestion in the prevention of VVR.
STUDY DESIGN AND METHODS: Blood pressure and heart rate (HR) during 5 minutes of standing were examined before and after BC in 93 donors. Because HR increase of 6 of 7 donors who developed syncopal VVR during standing after BC was 15 beats per minute (bpm) or greater, those with HR increase of 15 bpm or greater were determined as high-risk donors (n = 31). In another group (n = 117), 45 donors were identified as high risk based on the HR response before BC (≥15 bpm). The effect of 300 mL of water ingestion 15 minutes before BC on hemodynamic responses to standing and the rate of VVR after BC were analyzed.
RESULTS: Water ingestion given to the high-risk donors of the second group reduced HR increase with standing before BC (−6.6 ± 13.6 bpm, p < 0.02 vs. HR increase before water ingestion) and significantly suppressed VVR rate (2 of 45 donors with high risk, 4.4%, p < 0.04 vs. the first group; 6 of 31 high-risk donors, 19.4%).
CONCLUSION: HR response to standing before BC may detect the high-risk donors for VVR. For the high-risk donors, 300 mL of water ingestion may be a simple and effective way of prevention against syncopal VVR.     

Cyclosporine and sirolimus pharmacokinetics and drug-to-drug interactions in kidney transplant recipients

This study was conducted to evaluate the pharmacokinetics (pk) and drug interactions between cyclosporine (CsA) and sirolimus (SRL) in kidney transplant recipients. The morning (a.m.) and evening (p.m.) pk of CsA (4–5 mg/kg/dose) and SRL (2 mg, n  = 20; 5 mg, n  = 33) were evaluated on day 7 ( n  = 53). CsA showed circadian variation when comparing a.m. and p.m. administration [AUC: 8066 vs. 6699, P  < 0.001 (CI 970.9; 1763.6); C0: 272 vs. 245, P  = 0.007 (CI 7.5; 46.1)]. SRL showed dose-proportional pk. Significant and drug-to-drug concentration-dependent pk interactions were observed within a narrow concentration range for both drugs. A fivefold increase in SRL AUC (from a mean of 130 to 538 ng h/mL) was associated with a 25% increase in mean a.m. CsA AUC [7021 to 8811 ng h/mL, P  = 0.037, CI (−3461.2; −118.9)] and with a 42% increase in mean p.m. CsA AUC [5386–7639, P  = 0.024, CI (−4164.4; −340.7)]. A twofold increase in a.m. CsA AUC (from 5860 to 10 974 ng h/mL) was associated with a 70% increase in mean SRL AUC [223 to 380 ng h/mL, P  = 0.0026, CI (−291.7; −22.8)]. A twofold increase in p.m. CsA AUC (from 4573 to 9692 ng h/mL) was associated with a 63% increase in mean SRL AUC [246 to 400 ng h/mL, P  = 0.032, CI (−290.7; −16.6)]. CSA shows circadian pk regardless of sirolimus dose or blood concentration. Significant drug-to-drug interactions occur within narrow blood drug concentrations. The magnitude of the effect of CsA on SRL blood concentration is higher than that of SRL on CsA blood concentrations. These findings emphasize the need for therapeutic drug monitoring using this drug combination.     

Suboptimal effect of a three-factor prothrombin complex concentrate (Profilnine-SD) in correcting supratherapeutic international normalized ratio due to warfarin overdose

BACKGROUND: Plasma transfusion is standard therapy for urgent warfarin reversal in the United States. "Four-factor" prothrombin complex concentrate (PCC), available in Europe, has advantages over plasma therapy for warfarin reversal; however, only "three-factor" PCCs (containing relatively low Factor [F]VII) are available in the United States.
STUDY DESIGN AND METHODS: The efficacy of a three-factor PCC for urgent warfarin reversal was evaluated in 40 patients presenting with supratherapeutic international normalized ratio (ST-INR > 5.0) with bleeding (n = 29) or at high risk for bleeding (n = 11). In 13 patients, pre- and posttherapy vitamin K-dependent factors were assayed. Historical controls (n = 42) treated with plasma alone were used for rate of ST-INR correction comparison.
RESULTS: Treatment with plasma alone (mean, 3.6 units) lowered the INR to less than 3.0 in 63 percent of historical controls. Low-dose (25 U/kg) and high-dose (50 U/kg) PCC alone lowered INR to less than 3.0 in 50 and 43 percent of patients, respectively. Additional transfusion of a small amount of plasma (mean, 2.1 units) increased the rate of achieving an INR of less than 3.0 to 89 and 88 percent for low- and high-dose PCC therapy, respectively. FII, F IX, and FX increments were similar for PCC-treated patients with or without supplemental plasma; FVII was significantly higher in the PCC plus plasma group compared to the PCC-only group (p = 0.001).
CONCLUSION: Three-factor PCC does not satisfactorily lower ST-INR due to low FVII content. Infusion of a small amount of plasma increases the likelihood of satisfactory INR lowering.     

Finger counting: an alternative method for estimating pediatric weights

Objectives

We compared the accuracy of a conceptually simple pediatric weight estimation technique, the finger counting method, with other commonly used methods.

Methods

We prospectively collected cross-sectional data on a convenience sample of 207 children aged 1 to 9 presenting to our pediatric emergency department. Bland-Altman plots were constructed to compare the finger counting method to the Broselow tape method, parental estimate, the Luscombe formula, and the advanced pediatric life support (APLS) formula. Proportions within 10% and 20% of measured weight were compared.

Results

Mean difference and range of agreement in kilograms for Bland-Altman plots were as follows: − 1.8 (95% confidence interval [CI], − 2.3 to − 1.3) and 15.4 (95% CI, 13.6-17.2) for the finger counting method; − 1.4 (95% CI, − 2.0 to − 0.9) and 15.8 (95% CI, 13.9-17.6) for the Broselow method; − 0.02 (95% CI, − 0.53 to 0.49) and 14.8 (95% CI, 13-16.6) for parental estimate; 0.2 (95% CI, − 0.33 to 0.72) and 15.3 (95% CI, 13.5-17.2) for the Luscombe formula; and − 3.8 (95% CI, − 4.4 to − 3.2) and 17.2 (95% CI, 15.2-19.2) for the APLS formula. The finger counting method estimated weights within 10% in 59% of children (95% CI, 52%-65%) and within 20% in 87% of children (95% CI, 81%-91%). Proportions within 10% were similar for all methods, except the APLS method, which was lower.

Conclusions

The finger counting method is an acceptable alternative to the Broselow method for weight estimation in children aged 1 to 9 years. It outperforms the traditional APLS method but underestimates weights compared with parental estimate and the Luscombe formula.     

Bedside method to estimate actual body weight in the Emergency Department

Background

Actual body weight (ABW) is important for accurate drug dosing in emergency settings. Oftentimes, patients are unable to stand to be weighed accurately or clearly state their most recent weight.

Objective

Develop a bedside method to estimate ABW using simple anthropometric measurements.

Methods

Prospective, blinded, cross-sectional convenience sampling of adult Emergency Department (ED) patients. A multiple linear regression equation from Derivation Phase (n = 208: 121 males, 87 females) found abdominal and thigh circumferences (AC and TC) had the best fit and an inter-rater correlation of 0.99 and 0.96, respectively: Male ABW (kg) = −47.8 + 0.78 ∗ (AC) + 1.06 ∗ (TC); Female ABW = −40.2 + 0.47 ∗ (AC) + 1.30 ∗ (TC).

Results

Derivation phase: Number of patients (%) with a body weight estimation (BWE) > 10 kg from ABW for males/females were: 7 (6%)/1 (1%) for Patients, 46 (38%)/28 (32%) for Doctors, 38 (31%)/24 (27%) for Nurses, 75 (62%)/43 (49%) for 70 kg/60 kg convention, and 14 (12%)/8 (9%) using the anthropometric regression model. For validation phase (55 males, 44 females): Gold standard ABW mean (SD) male/female = 83.6 kg (14.3)/71.5 kg (18.9) vs. anthropometric regression model = 86.3 kg (14.7)/73.3 kg (15.1). R² = 0.89, p < 0.001. The number (%) for males/females with a BWE > 10 kg using the anthropometric regression model = 8 (15%)/11 (27%).

Conclusions

For male patients, a regression model using supine thigh and abdominal circumference measurements seems to provide a useful and more accurate alternative to physician, nurse, or standard 70-kg male conventional estimates, but was less accurate for use in female patients.     

Genetic variation in fibrinogen; its relationship to fibrinogen levels and the risk of myocardial infarction and ischemic stroke

Summary.  Background: Confounding by common causes and reverse causation have been proposed as explanations for the association between high fibrinogen levels and cardiovascular disease. Genetic variants can alter fibrinogen characteristics and are not subject to these problems. Objectives: To determine the fibrinogen plasma levels for genotypic variants in fibrinogen-Aα (FGA Thr312Ala) and fibrinogen-Bβ (FGB − 455G/A), and whether these variants are associated with arterial thrombosis. Methods: Fibrinogen genotypes were determined in a population-based case–control study including women aged 18–50 years; 218 cases with myocardial infarction, 192 cases with ischemic stroke, and 769 healthy controls. Fibrinogen levels were determined in the control population. Results: The FGB − 455G/A variant increased plasma fibrinogen levels, whereas the FGA Thr312Ala variant lowered plasma fibrinogen levels, albeit to a modest extent. The risk of ischemic stroke was altered when the homozygote minor allele was compared with the homozygote major allele. The FGA Thr312Ala single-nucleotide polymorphism (SNP) was associated with a decrease in risk [odds ratio (OR) 0.43; 95% confidence interval (CI) 0.21–0.87], whereas the FGB − 455G/A SNP might have increased the risk (OR 1.76; 95% CI  0.7–4.03). The risk of myocardial infarction was not altered for either SNP (FGA Thr312Ala, OR 0.98, 95% CI  0.40–2.40; FGB − 455G/A, OR 0.98, 95% CI  0.40–2.40). Conclusions: With the genetic variations as markers of plasma fibrinogen levels alterations, thereby ruling out confounding and reverse causation, our results suggest that plasma fibrinogen levels could play a more pronounced role as risk factors for ischemic stroke than for myocardial infarction.     

Emergency weight estimation in Pacific Island and Maori children who are large-for-age

Objective: Methods to estimate weights of children requiring resuscitation appeared to underestimate the weight of Pacific Island and Maori children. This study sought to quantify differences between real and estimated weights, study links with ethnicity and derive a new estimation method for large‐for‐age children. Method: Data were collected prospectively for 3 months. Weights were estimated by formulae described by Shann, Leffler, the Advanced Paediatric Life Support (APLS) formula, the Oakley resuscitation chart and the Broselow tape. Results: Of the 909 children included, 46% were of Pacific Island and 25% were of Maori origin. Differences between actual and estimated weights were significantly greater (P < 0.05) for the Pacific Island group using all methods of estimation. Maori differences were significantly greater than European differences using Oakley and Broselow methods (P < 0.05). The Broselow tape was the method most likely to underestimate weight in Pacific Island and Maori children. A new formula was derived from non‐linear regression analysis, leading to a new chart. Conclusion: Current emergency methods underestimate weight in Pacific Island and Maori children. We recommend a new chart for these children.     

Validation of the Luscombe weight formula for estimating children's weight

Objective: Several paediatric weight estimation methods have been described for use when direct weight measurement is not possible. A new age‐based weight estimation method has recently been proposed. The Luscombe formula, applicable to children aged 1–10 years, is calculated as (3 × age in years) + 7. Our objective was to externally validate this formula using an existing database. Method: Secondary analysis of a prospective observational cohort study. Data collected included height, age, ethnicity and measured weight. The outcome of interest was agreement between estimated weight using the Luscombe formula and measured weight. Secondary outcome was comparison with performance of Argall, APLS and Best Guess formulae. Accuracy of weight estimation methods was compared using mean difference (bias), 95% limits of agreement, root mean square error and proportion with agreement within 10%. Results: Four hundred and ten children were studied. Median age was 4 years; 54.4% were boys. Mean body mass index was 17 kg/m² and mean measured weight was 21.2 kg. The Luscombe formula had a mean difference of 0.66 kg (95% limits of agreement ?9.9 to +11.3 kg; root mean square error of 5.44 kg). 45.4% of estimates were within 10% of measured weight. The Best Guess and Luscombe formulae performed better than Argall or APLS formulae. Conclusion: The Luscombe formula is among the more accurate age‐based weight estimation formulae. When more accurate methods (e.g. parental estimation or the Broselow tape) are not available, it is an acceptable option for estimating children's weight.