Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland.
Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
Acta Anaesthesiol Scand. 2018 Nov;62(10):1389-1395. doi: 10.1111/aas.13179. Epub 2018 Jun 25.
Paediatric emergency tapes provide drug dosing based on the patient's estimated body weight. Unfortunately, published data revealed an unsatisfactory accuracy. A newly developed digital algorithm for weight estimation (CLAWAR) allowing a three-staged habitus adaptation (normal, obese, or cachectic; CLAWAR-3) demonstrated a higher accuracy for weight estimation compared to paediatric emergency tapes. However, the incidence of incorrectly evaluated habitus was 27%. A five-staged habitus adaptation with figural images was suggested by Wells et al to improve habitus and weight estimation. Therefore, CLAWAR was modified with five habitus stages including figural images (CLAWAR-5). We hypothized CLAWAR-5 improves the accuracy of weight estimation.
After obtaining informed written parental consent patients were included in this single centre, prospective clinical observation trial. Body weight estimations by CLAWAR-3 and CLAWAR-5 within ±10% of the actual body weight were compared. Furthermore, the incidence of correct evaluated habitus was calculated. McNemar Tests were used for statistical analysis. Results presented as median (interquartiles), P < .003 considered significant.
In total, 312 patients aged 3.3 years (0.7-6.6), with a body length of 95.9 cm (70.0-121.2), weighing 14.8 kg (8.1-22.5), were included. Both CLAWAR-3 and CLAWAR-5 showed equivalent accuracy for weight estimation within the ±10% interval (62.2% vs 60.6%, P = .609). Despite adding figural images, the incidence of correct evaluated habitus with CLAWAR-5 (46.8%) was worse than with CLAWAR-3 (66.7%).
The five-staged habitus-adapted method could not improve the accuracy of weight estimation. Furthermore, the error rate of habitus classification was not reduced by the implementation of figural images.
儿科急救带根据患者估计的体重提供药物剂量。然而，已发表的数据显示其准确性并不令人满意。一种新开发的数字体重估计算法（CLAWAR）允许进行三阶段体型适应（正常、肥胖或消瘦；CLAWAR-3），与儿科急救带相比，该算法在体重估计方面具有更高的准确性。然而，不正确评估体型的发生率为 27%。Wells 等人建议使用五阶段体型适应和图形图像来改善体型和体重估计。因此，CLAWAR 通过包括图形图像的五个体型阶段进行了修改（CLAWAR-5）。我们假设 CLAWAR-5 可以提高体重估计的准确性。
在获得书面知情同意后，将患者纳入本中心前瞻性临床观察试验。比较 CLAWAR-3 和 CLAWAR-5 在±10%的实际体重范围内的体重估计值。此外，还计算了正确评估体型的发生率。使用 McNemar 检验进行统计学分析。结果以中位数（四分位间距）表示，P<.003 被认为具有统计学意义。
共纳入 312 名年龄 3.3 岁（0.7-6.6 岁）、身高 95.9cm（70.0-121.2cm）、体重 14.8kg（8.1-22.5kg）的患者。CLAWAR-3 和 CLAWAR-5 均在±10%的范围内显示出相同的体重估计准确性（62.2%对 60.6%，P=.609）。尽管添加了图形图像，但 CLAWAR-5 正确评估体型的发生率（46.8%）仍低于 CLAWAR-3（66.7%）。
五阶段体型适应方法不能提高体重估计的准确性。此外，实施图形图像并没有降低体型分类的错误率。
