Wells Mike, Goldstein Lara Nicole, Bentley Alison
Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
, Postnet Suite 429, Private Bag X1510, Glenvista, 2058, South Africa.
Int J Emerg Med. 2017 Sep 21;10(1):29. doi: 10.1186/s12245-017-0156-5.
The safe and effective administration of fluids and medications during the management of medical emergencies in children depends on an appropriately determined dose, based on body weight. Weight can often not be measured in these circumstances and a convenient, quick and accurate method of weight estimation is required. Most methods in current use are not accurate enough, but the newer length-based, habitus-modified (two-dimensional) systems have shown significantly higher accuracy. This meta-analysis evaluated the accuracy of weight estimation systems in children. Articles were screened for inclusion into two study arms: to determine an appropriate accuracy target for weight estimation systems; and to evaluate the accuracy of existing systems using standard meta-analysis techniques. There was no evidence found to support any specific goal of accuracy. Based on the findings of this study, a proposed minimum accuracy of 70% of estimations within 10% of actual weight (PW10 > 70%), and 95% within 20% of actual weight (PW20 > 95%) should be demonstrated by a weight estimation system before being considered to be accurate. In the meta-analysis, the two-dimensional systems performed best. The Mercy method (PW10 70.9%, PW20 95.3%), the PAWPER tape (PW10 78.0%, PW20 96.6%) and parental estimates (PW10 69.8%, PW20 87.1%) were the most accurate systems investigated, with the Broselow tape (PW10 55.6%, PW20 81.2%) achieving a lesser accuracy. Age-based estimates achieved a very low accuracy. Age- and length-based systems had a substantial difference in over- and underestimation of weight in high-income and low- and middle-income populations. A benchmark for minimum accuracy is recommended for weight estimation studies and a PW10 > 70% with PW20 > 95% is suggested. The Mercy method, the PAWPER tape and parental estimates were the most accurate weight estimation systems followed by length-based and age-based systems. The use of age-based formulas should be abandoned because of their poor accuracy.
在儿童医疗急救管理过程中，安全有效地给予液体和药物取决于根据体重适当确定剂量。在这些情况下，体重往往无法测量，因此需要一种方便、快速且准确的体重估算方法。目前使用的大多数方法不够准确，但更新的基于身长、体型修正（二维）系统已显示出显著更高的准确性。这项荟萃分析评估了儿童体重估算系统的准确性。文章筛选后分为两个研究组：确定体重估算系统的适当准确性目标；以及使用标准荟萃分析技术评估现有系统的准确性。未发现有证据支持任何特定的准确性目标。根据本研究结果，在被认为准确之前，体重估算系统应证明建议的最低准确性为：70%的估算值在实际体重的10%以内（PW10 > 70%），95%的估算值在实际体重的20%以内（PW20 > 95%）。在荟萃分析中，二维系统表现最佳。所研究的最准确系统是梅西法（PW10 70.9%，PW20 95.3%）、PAWPER卷尺（PW10 78.0%，PW20 96.6%）和家长估算值（PW10 69.8%，PW20 87.1%），而布罗泽洛卷尺（PW10 55.6%，PW20 81.2%）的准确性较低。基于年龄的估算准确性非常低。基于年龄和身长的系统在高收入以及低收入和中等收入人群体重的高估和低估方面存在很大差异。建议为体重估算研究设定最低准确性基准，建议PW10 > 70%且PW20 > 95%。梅西法、PAWPER卷尺和家长估算值是最准确的体重估算系统，其次是基于身长和基于年龄的系统。由于准确性较差，应放弃使用基于年龄的公式。
