Cattermole Giles N, Wells Mike
Department of Emergency Medicine King's College Hospital National Health Service Trust London UK.
Department of Emergency Medicine University of the Witwatersrand Johannesburg South Africa.
J Am Coll Emerg Physicians Open. 2021 Jul 21;2(4):e12515. doi: 10.1002/emp2.12515. eCollection 2021 Aug.
Many emergency drug and fluid doses are weight dependent in adults, but in resuscitation and low-resource settings it can be impractical or impossible to weigh a patient. It is especially important to obtain accurate weight estimation for dose calculations for emergency drugs with narrow therapeutic ranges. Several weight estimation methods have been proposed for use in adults, but none is widely established. The aim of this study was to compare the accuracy of adult weight estimation methods.
Demographic and body measurement data were obtained from the US National Health and Nutrition Examination Survey (NHANES), and 7 previously published weight estimation methods were used to estimate the weight for each individual. The primary outcomes were the proportions of estimates within 10% and 20% of actual weight (P10, P20). An acceptable accuracy was predetermined to be P10 = 70% and P20 = 95%.
The data set included 5158 adults (51.2% women) with sufficient data to calculate all weight estimation methods. The Lorenz method performed best (P10 = 86.8%, P20 = 99.4%) and met the standard of acceptability across sex and body mass index subgroups. The Mercy and PAWPER XL-MAC methods performed acceptably in non-obese adults.
The ideal weight estimation method should be accurate, rapid, simple, and feasible. This study has demonstrated the accuracy of 7 methods. The Lorenz method performed best but is complex and likely to be difficult to apply in resuscitation settings. Other simpler and quicker methods are at least as accurate as the best methods widely used in children, and there is potential for further calibrating these for use in adults before validation in real-world studies.
许多成人急救药物和液体剂量取决于体重，但在复苏和资源匮乏的环境中，对患者进行称重可能不切实际或无法做到。对于治疗范围较窄的急救药物，准确估算体重以进行剂量计算尤为重要。已提出几种用于成人的体重估算方法，但尚无一种被广泛采用。本研究的目的是比较成人体重估算方法的准确性。
从美国国家健康与营养检查调查（NHANES）获取人口统计学和身体测量数据，并使用7种先前发表的体重估算方法来估算每个个体的体重。主要结果是估算值在实际体重的10%和20%范围内的比例（P10、P20）。预先确定可接受的准确性为P10 = 70%和P20 = 95%。
数据集包括5158名成年人（51.2%为女性），有足够数据来计算所有体重估算方法。洛伦兹方法表现最佳（P10 = 86.8%，P20 = 99.4%），并且在性别和体重指数亚组中均达到了可接受标准。梅西方法和PAWPER XL - MAC方法在非肥胖成年人中表现尚可。
理想的体重估算方法应准确、快速、简单且可行。本研究证明了7种方法的准确性。洛伦兹方法表现最佳，但较为复杂，在复苏环境中可能难以应用。其他更简单快捷的方法至少与广泛用于儿童的最佳方法一样准确，并且在实际研究验证之前，有进一步校准这些方法以用于成人的潜力。
