Wetzel Oliver, Schmidt Alexander R, Seiler Michelle, Scaramuzza Davide, Seifert Burkhardt, Spahn Donat R, Stein Philipp
Institute of Anaesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Department of Anaesthesiology, University Children's Hospital, Zurich, Switzerland.
J Clin Monit Comput. 2018 Jun;32(3):571-578. doi: 10.1007/s10877-017-0041-z. Epub 2017 Jun 28.
The aim of this study was to test the feasibility and accuracy of a smartphone application to measure the body length of children using the integrated camera and to evaluate the subsequent weight estimates. A prospective clinical trial of children aged 0-<13 years admitted to the emergency department of the University Children's Hospital Zurich. The primary outcome was to validate the length measurement by the smartphone application «Optisizer». The secondary outcome was to correlate the virtually calculated ordinal categories based on the length measured by the app to the categories based on the real length. The third and independent outcome was the comparison of the different weight estimations by physicians, nurses, parents and the app. For all 627 children, the Bland Altman analysis showed a bias of -0.1% (95% CI -0.3-0.2%) comparing real length and length measured by the app. Ordinal categories of real length were in excellent agreement with categories virtually calculated based upon app length (kappa = 0.83, 95% CI 0.79-0.86). Children's real weight was underestimated by physicians (-3.3, 95% CI -4.4 to -2.2%, p < 0.001), nurses (-2.6, 95% CI -3.8 to -1.5%, p < 0.001) and parents (-1.3, 95% CI -1.9 to -0.6%, p < 0.001) but overestimated by categories based upon app length (1.6, 95% CI 0.3-2.8%, p = 0.02) and categories based upon real length (2.3, 95% CI 1.1-3.5%, p < 0.001). Absolute weight differences were lowest, if estimated by the parents (5.4, 95% CI 4.9-5.9%, p < 0.001). This study showed the accuracy of length measurement of children by a smartphone application: body length determined by the smartphone application is in good agreement with the real patient length. Ordinal length categories derived from app-measured length are in excellent agreement with the ordinal length categories based upon the real patient length. The body weight estimations based upon length corresponded to known data and limitations. Precision of body weight estimations by paediatric physicians and nurses were comparable and not different to length based estimations. In this non-emergency setting, parental weight estimation was significantly better than all other means of estimation (paediatric physicians and nurses, length based estimations) in terms of precision and absolute difference.
本研究的目的是测试一款利用集成摄像头测量儿童身长的智能手机应用程序的可行性和准确性，并评估随后的体重估计值。对苏黎世大学儿童医院急诊科收治的0至<13岁儿童进行了一项前瞻性临床试验。主要结果是验证智能手机应用程序“Optisizer”的身长测量。次要结果是将基于应用程序测量的身长虚拟计算的序数类别与基于实际身长的类别进行关联。第三个独立结果是比较医生、护士、家长和该应用程序对不同体重的估计。对于所有627名儿童，Bland Altman分析显示，实际身长与应用程序测量的身长相比，偏差为-0.1%（95%可信区间-0.3-0.2%）。实际身长的序数类别与基于应用程序测量的身长虚拟计算的类别高度一致（kappa = 0.83，95%可信区间0.79-0.86）。医生（-3.3，95%可信区间-4.4至-2.2%，p < 0.001）、护士（-2.6，95%可信区间-3.8至-1.5%，p < 0.001）和家长（-1.3，95%可信区间-1.9至-0.6%，p < 0.001）低估了儿童的实际体重，但基于应用程序测量的身长类别（1.6，95%可信区间0.3-2.8%，p = 0.02）和基于实际身长的类别（2.3，95%可信区间1.1-3.5%，p < 0.001）高估了儿童的实际体重。如果由家长进行估计，绝对体重差异最小（5.4，95%可信区间4.9-5.9%，p < 0.001）。本研究显示了智能手机应用程序测量儿童身长的准确性：智能手机应用程序确定的身长与患者实际身长高度一致。从应用程序测量的身长得出的序数长度类别与基于患者实际身长的序数长度类别高度一致。基于身长的体重估计与已知数据和局限性相符。儿科医生和护士对体重估计的精确性与基于身长的估计相当，没有差异。在这种非紧急情况下，就精确性和绝对差异而言，家长对体重的估计明显优于所有其他估计方法（儿科医生和护士、基于身长的估计）。
