Wells Mike, Goldstein Lara Nicole, Bentley Alison
Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
Afr J Emerg Med. 2017;7(Suppl):S36-S54. doi: 10.1016/j.afjem.2017.06.001. Epub 2017 Sep 22.
When weight cannot be measured during the management of medical emergencies in children, a convenient, quick and accurate method of weight estimation is required, as many drug doses and other interventions are based on body weight. Many weight estimation methodologies in current use have been shown to be inaccurate, especially in low- and middle-income countries with a high prevalence of underweight children. This meta-analysis evaluated the accuracy of weight estimation systems in children from studies from low- and middle-income countries.
Articles from low- and middle-income countries were screened for inclusion to evaluate and compare the accuracy of existing systems and the newer dual length- and habitus-based methods, using standard meta-analysis techniques.
The 2D systems and parental estimates performed best overall. The PAWPER tape, parental estimates, the Wozniak method and the Mercy method were the most accurate systems with percentage of weight estimates within 10% of actual weight (PW10) accuracies of 86.9%, 80.4%, 72.1% and 71.4% respectively. The Broselow tape (PW10 47.1%) achieved a moderate accuracy and age-based estimates a very low accuracy (PW10 11.8-47.5%).
The PAWPER tape, the Wozniak method and the Mercy method achieved an acceptable level of accuracy in studies from low- and middle-income countries and should preferentially be used and further advanced for clinical emergency medicine practice. Parental estimates may be considered if the regular caregiver of the child is present and a recent measured weight is known. The Broselow tape and age-based formulas should be abandoned in low- and middle-income country populations as they are potentially dangerously inaccurate.
在儿童医疗急救管理过程中，若无法测量体重，则需要一种方便、快速且准确的体重估算方法，因为许多药物剂量及其他干预措施都基于体重。目前使用的许多体重估算方法已被证明不准确，尤其是在体重不足儿童患病率较高的低收入和中等收入国家。这项荟萃分析评估了来自低收入和中等收入国家研究中儿童体重估算系统的准确性。
筛选来自低收入和中等收入国家的文章以纳入研究范围，运用标准荟萃分析技术评估和比较现有系统以及基于身长和体型的较新方法的准确性。
二维系统和家长估计总体表现最佳。PAWPER卷尺、家长估计、沃兹尼亚克方法和梅西方法是最准确的系统，体重估计值在实际体重的10%以内（PW10）的准确率分别为86.9%、80.4%、72.1%和71.4%。布罗泽洛卷尺（PW10为47.1%）准确性中等，基于年龄的估计准确性非常低（PW10为11.8 - 47.5%）。
在低收入和中等收入国家的研究中，PAWPER卷尺、沃兹尼亚克方法和梅西方法达到了可接受的准确性水平，应优先用于临床急诊医学实践并进一步改进完善。如果孩子的常规照料者在场且已知最近一次测量的体重，则可以考虑家长估计值。在低收入和中等收入国家人群中应摒弃布罗泽洛卷尺和基于年龄的公式法，因为它们可能存在危险的不准确情况。
