Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia, USA.
The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA.
Prehosp Emerg Care. 2023;27(2):263-268. doi: 10.1080/10903127.2022.2028045. Epub 2022 Feb 3.
Up to 40% of children who receive a medication from emergency medical services (EMS) are subject to a dosing error. One of the reasons for this is difficulties adjusting dosages for weight. Converting weights from pounds to kilograms complicates this further. This is the rationale for the National EMS Quality Alliance measure Pediatrics-03b, which measures the proportion of children with a weight documented in kilograms. However, there is little evidence that this practice is associated with lower rates of dosing errors. Therefore, our objective was to determine whether EMS documentation of weight in kilograms was associated with a lower rate of pediatric medication dosing errors. We conducted a retrospective cross-sectional study of children 0-14 y/o in the 2016-17 electronic Maryland Emergency Medical Services Data System that received a weight-based medication. Using validated age-based formulas, we assigned a weight to patients without one documented. Doses were classified as errors and severe errors if they deviated from the state protocol by >20% or >50%, respectively. We compared the dosage errors in the two groups and completed secondary analyses for specific medications and age groups. We identified 3,618 cases of medication administration, 53% of which had a documented weight. Patients with a documented weight had a significantly lower overall dose error rate than those without (22 vs. 26%, <.05). A sensitivity analysis in which we assigned a weight to those patients with a weight recorded did not significantly change this result. Sub-analyses by individual medication showed that only epinephrine (34 vs. 56%, <.05) and fentanyl (10 vs. 31%, <.05) had significantly lower dosing error rates for patients with a documented weight. Infants were the only age group where documenting a weight was associated with a lower dosing error rate (33 vs. 53% <.05). Our findings suggest that documenting a weight in kilograms is associated with a small but significantly lower rate of pediatric dosing errors by EMS. Documenting a weight in kilograms appears particularly important for specific medications and patient age groups. Additional strategies (including age-based standardized dosing) may be needed to further reduce pediatric dosing errors by EMS.
高达 40%接受急救医疗服务（EMS）用药的儿童会出现剂量错误。造成这种情况的原因之一是难以根据体重调整剂量。将体重从磅转换为公斤会使情况更加复杂。这就是国家 EMS 质量联盟 Pediatrics-03b 措施的基本原理，该措施衡量了有记录的公斤体重的儿童比例。然而，几乎没有证据表明这种做法与较低的用药剂量错误率有关。因此，我们的目标是确定 EMS 记录公斤体重是否与儿科用药剂量错误率较低有关。我们对 2016-17 年马里兰州电子急救医疗服务数据系统中接受基于体重的药物治疗的 0-14 岁儿童进行了回顾性横断面研究。我们使用经过验证的基于年龄的公式为没有记录体重的患者分配体重。剂量被归类为误差，如果偏差超过州方案的 20%或 50%，则分别归类为严重误差。我们比较了两组的剂量误差，并对特定药物和年龄组进行了二次分析。我们确定了 3618 例药物管理病例，其中 53%有记录的体重。有记录体重的患者总体剂量误差率明显低于无记录体重的患者（22%对 26%，<.05）。我们对那些体重记录的患者分配体重的敏感性分析并未显著改变这一结果。对个别药物的亚分析表明，只有肾上腺素（34%对 56%，<.05）和芬太尼（10%对 31%，<.05）的记录体重患者的用药剂量错误率显著降低。婴儿是唯一记录体重与较低用药剂量错误率相关的年龄组（33%对 53%，<.05）。我们的研究结果表明，记录公斤体重与 EMS 儿科用药剂量错误率的微小但显著降低相关。记录公斤体重对于特定药物和患者年龄组似乎尤为重要。可能需要其他策略（包括基于年龄的标准化剂量）来进一步降低 EMS 的儿科用药剂量错误率。
