Akkawi El Edelbi Ranaa, Lindemalm Synnöve, Nydert Per, Eksborg Staffan
Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden.
Division of Pediatrics, Karolinska University Hospital, Astrid Lindgren Children's Hospital, 171 76, Stockholm, Sweden.
Int J Pediatr Adolesc Med. 2021 Dec;8(4):221-228. doi: 10.1016/j.ijpam.2020.09.003. Epub 2020 Sep 19.
The aim of this study was to use Body Surface Area (BSA) data calculated with the Mosteller equation to test potential new equations that estimate BSA using Body Weight (BW) alone in children aged 0-18 years.Mosteller's equation, the golden standard at our hospital, was used to calculate the BSA in infants and children aged 0-18 years using BW and height data from 27,440 hospital visits by 20,635 patients over one year.
The best fit of three nonlinear regression equations (third-order polynomial, Meeh-type, and modified Boyd self-adjusting-type) to a plot of the calculated Mosteller BSA values versus BW was then investigated. The correlation between the BSA values estimated by these equations and the Mosteller BSA values was established by the Spearman rank correlation test. Bias and precision were evaluated as outlined by Sheiner and Beal. Measured and estimated BSA values were compared using the Eksborg plot.
The estimated BSA values from all three equations and the BSA values from the Mosteller equation were closely correlated ( < .0001). The third-order polynomial and Meeh-type equations overestimated BSA by 0.13% and 0.40%, respectively, while the Boyd self-adjusted-type equation underestimated BSA by 0.060%. For the entire pediatric population, the best fit was obtained with the Meeh-type equation: 99.2% of the Meeh/Mosteller BSA ratios were within the range of 0.9-1.1 when compared with 98.3% and 97.2% for the polynomial and Boyd-type equations, respectively.
A single Meeh-type equation can be used to predict the results of Mosteller equation when H is not available with high precision and accuracy in children aged 0-18 years, including term neonates. We now plan to include the results of this study in CPOE systems in Sweden to improve drug dosage in all children.
本研究的目的是使用通过莫斯特勒方程计算的体表面积（BSA）数据，来测试仅使用体重（BW）估算0至18岁儿童体表面积的潜在新方程。莫斯特勒方程是我们医院的金标准，用于根据20635名患者在一年中27440次医院就诊时的体重和身高数据，计算0至18岁婴幼儿和儿童的体表面积。
然后研究了三个非线性回归方程（三阶多项式、米氏型和改良博伊德自调整型）对计算出的莫斯特勒体表面积值与体重的关系图的最佳拟合情况。通过斯皮尔曼等级相关检验确定这些方程估算的体表面积值与莫斯特勒体表面积值之间的相关性。按照谢纳和比尔概述的方法评估偏差和精密度。使用埃克斯堡图比较测量的和估算的体表面积值。
所有三个方程估算的体表面积值与莫斯特勒方程的体表面积值密切相关（<0.0001）。三阶多项式方程和米氏型方程分别高估体表面积0.13%和0.40%，而博伊德自调整型方程低估体表面积0.060%。对于整个儿科人群，米氏型方程的拟合效果最佳：与多项式方程和博伊德型方程分别为98.3%和97.2%相比，99.2%的米氏/莫斯特勒体表面积比值在0.9至1.1范围内。
在无法获得身高（H）的情况下，单个米氏型方程可用于高精度和准确地预测0至18岁儿童（包括足月儿）的莫斯特勒方程结果。我们现在计划将本研究结果纳入瑞典的临床医嘱录入系统，以改善所有儿童的药物剂量。
