验证 PAWPER XL-MAC 胶带在中低收入国家幼儿全身重量估计中的应用。
A validation of the PAWPER XL-MAC tape for total body weight estimation in preschool children from low- and middle-income countries.
机构信息
Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
出版信息
PLoS One. 2019 Jan 7;14(1):e0210332. doi: 10.1371/journal.pone.0210332. eCollection 2019.
IMPORTANCE
The PAWPER tape system is one of the three most accurate paediatric weight estimation systems in the world. The latest version of the tape, which does not rely on a subjective assessment of habitus, is the PAWPER XL-MAC method which uses length and mid-arm circumference (MAC) to estimate weight. It was derived and validated in a population in the USA and has not yet been fully validated in a population from a resource-limited setting.
OBJECTIVE
The objective of this study was to evaluate the performance of the PAWPER XL-MAC tape weight estimation system in a large dataset sample of children from resource-limited settings.
METHODS
This was a "virtual" study in which weight estimates were generated using the PAWPER XL-MAC tape and Broselow tape 2007B and 2011A editions in a very large open access dataset. The dataset contained anthropometric information of children aged 6 to 59 months from standardised nutritional surveys in 51 low- and middle-income countries. The performance of PAWPER XL-MAC method was compared with the Broselow tape and a new length- and habitus-based tape, the Ralston method.
MAIN OUTCOMES AND MEASURES
The bias of the weight estimation methods was assessed using the mean percentage error (MPE) and precision using the 95% limits of agreement (LOA) of the MPE. The overall accuracy was denoted by the percentage of weight estimates falling within 10% and 20% of actual weight (abbreviated as p10 and p20 respectively).
RESULTS
The MPE (LOA) for the PAWPER XL-MAC tape, the Broselow 2007B and 2011A and Ralston method were 1.9 (-15.3, 19.2), 5.4 (-15.9, 26.7), 7.7 (-13.3, 30.5) and -0.7 (-20.2, 19.3) respectively. The p10 and p20 for each method were 79.3% and 96.9% for the PAWPER XL-MAC tape, 64.3% and 91.0% for the Broselow tape 2007B, 55.5% and 85.9% for the Broselow tape 2011A and 67.4 and 94.0% for the Ralston method respectively. The PAWPER XL-MAC system was statistically significantly more accurate than the Broselow tape 2011A, the Broselow tape 2007B and the Ralston method. The relative difference in accuracy (p10) was 43% (odds ratio 4.4 (4.4, 4.5), p<0.001), 23% (odds ratio 2.9 (2.8, 2.9), p<0.001) and 18% (odds ratio 1.8 (1.8, 1.8), p<0.001) compared to each method, respectively.
CONCLUSIONS AND RELEVANCE
The PAWPER XL-MAC tape performed well in this study and was statistically significantly more accurate than both the Broselow tape editions and the Ralston method. This difference was substantial and clinically important. The tape did not perform as well at extremes of habitus-type, however, and might benefit from recalibration.
重要性
PAWPER 带系统是世界上最准确的三种儿科体重估计系统之一。最新版本的带系统不依赖于对体型的主观评估，即 PAWPER XL-MAC 方法，它使用长度和上臂周长（MAC）来估计体重。该方法在美国人群中进行了推导和验证，尚未在资源有限的人群中得到充分验证。
目的
本研究的目的是评估 PAWPER XL-MAC 带体重估计系统在资源有限环境下的大型数据集样本中的表现。
方法
这是一项“虚拟”研究，在一个非常大的开放获取数据集，使用 PAWPER XL-MAC 带和 Broselow 带 2007B 和 2011A 版本生成体重估计值。该数据集包含来自 51 个中低收入国家标准化营养调查的 6 至 59 个月大的儿童的人体测量信息。与 Broselow 带和新的基于长度和体型的 Ralston 方法相比，评估了 PAWPER XL-MAC 方法的性能。
主要结果和测量
使用平均百分比误差（MPE）评估体重估计的偏差，并使用 MPE 的 95%一致性界限（LOA）评估精度。整体准确性表示实际体重的 10%和 20%内的体重估计百分比（缩写为 p10 和 p20）。
结果
PAWPER XL-MAC 带、Broselow 2007B 和 2011A 以及 Ralston 方法的 MPE（LOA）分别为 1.9（-15.3，19.2）、5.4（-15.9，26.7）、7.7（-13.3，30.5）和-0.7（-20.2，19.3）。每种方法的 p10 和 p20 分别为 PAWPER XL-MAC 带的 79.3%和 96.9%、Broselow 带 2007B 的 64.3%和 91.0%、Broselow 带 2011A 的 55.5%和 85.9%以及 Ralston 方法的 67.4%和 94.0%。PAWPER XL-MAC 系统的准确性明显优于 Broselow 带 2011A、Broselow 带 2007B 和 Ralston 方法。准确性的相对差异（p10）分别为 43%（比值比 4.4（4.4，4.5），p<0.001）、23%（比值比 2.9（2.8，2.9），p<0.001）和 18%（比值比 1.8（1.8，1.8），p<0.001）。
结论和相关性
PAWPER XL-MAC 带在本研究中表现良好，与 Broselow 带两个版本和 Ralston 方法相比，统计学上准确性更高。这种差异是实质性的，具有临床意义。然而，该带在体型类型的极端情况下表现不佳，可能需要重新校准。
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