Wells Mike, Goldstein Lara
Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
Afr J Emerg Med. 2020 Jun;10(2):74-80. doi: 10.1016/j.afjem.2020.01.005. Epub 2020 Feb 7.
The accuracy of drug dosing calculations during medical emergencies in children has not been evaluated extensively. The objectives of this study were to evaluate the accuracy of drug dose calculations using the Broselow tape, the PAWPER XL tape plus its companion drug-dosing guide, a custom-designed mobile phone app and no drug-dosing aid (control group).
This was a prospective study in which 32 emergency medicine volunteers participated in eight simulations of common paediatric emergency conditions, using children models. The participants used the three methods to estimate the children's weight and calculate drug doses. The accuracy of and time taken for the drug dose determinations were then evaluated for each of the methods.
The overall accuracy of drug dose determinations was extremely and potentially dangerously low in the control group in which no dosing guide was used as well as in the Broselow tape group (<20% of doses were correct). The accuracy was significantly higher with the PAWPER XL tape group and the mobile app group (47% and 31% respectively). The times taken to obtain the required information did not differ in a clinically meaningful magnitude.
Both an accurate weight estimation and a dosing guide with comprehensive information were necessary to produce an accurate prescription. The information on the Broselow tape was not sufficient for this purpose. The current guidelines recommending the use of tapes with limited information should be revised. The results from the comprehensive dosing guides were substantially better, but still had a lower proportion of accurate prescriptions than desirable. The role of training in every aspect of the emergency paediatric weight estimation and drug dosing procedure cannot be underestimated and should be routine in any environment where emergency care may be needed.
儿童医疗急救期间药物剂量计算的准确性尚未得到广泛评估。本研究的目的是评估使用 Broselow 卷尺、PAWPER XL 卷尺及其配套药物剂量指南、定制设计的手机应用程序以及不使用药物剂量辅助工具（对照组）进行药物剂量计算的准确性。
这是一项前瞻性研究，32 名急诊医学志愿者使用儿童模型参与了八次常见儿科紧急情况的模拟。参与者使用这三种方法估计儿童体重并计算药物剂量。然后对每种方法的药物剂量测定准确性和所需时间进行评估。
在未使用剂量指南的对照组以及 Broselow 卷尺组中，药物剂量测定的总体准确性极低且可能存在危险（正确剂量不到 20%）。PAWPER XL 卷尺组和移动应用程序组的准确性明显更高（分别为 47%和 31%）。获取所需信息所用时间在临床意义上没有差异。
准确估计体重和提供全面信息的剂量指南对于开具准确处方都是必要的。Broselow 卷尺上的信息不足以达到此目的。当前推荐使用信息有限的卷尺的指南应予以修订。全面剂量指南的结果要好得多，但准确处方的比例仍低于理想水平。在儿科急诊体重估计和药物给药程序的各个方面进行培训的作用不可低估，在任何可能需要紧急护理的环境中都应将其作为常规。
