Waltuch Temima, Munjal Kevin, Loo George T, Lim Czer Anthoney
From the Department of Emergency Medicine, Hackensack University Medical Center, Hackensack, NJ.
Department of Emergency Medicine.
Pediatr Emerg Care. 2022 May 1;38(5):e1257-e1261. doi: 10.1097/PEC.0000000000002587. Epub 2022 Jan 25.
Inaccurate weight estimation is a contributing factor to medical error in pediatric emergencies, especially in the prehospital setting. Current American Heart Association guidelines recommend the use of length-based weight estimation tools such as the Broselow tape. We developed the AiRDose smartphone application that uses augmented reality to provide length-based weight estimates, as well as medication dosing, defibrillation energy, and equipment sizing recommendations; AiRDose was programmed to use Broselow conversions to obtain these estimates. The primary objective was to compare the length estimated by AiRDose with the actual length obtained by the standard tape measure. The secondary objectives were to compare the estimated weights and critical medication doses from AiRDose with current established methods.
In this prospective validation study, lengths and estimated weights were obtained for children presenting to 2 emergency departments using AiRDose, Broselow, and a standard tape measure; actual weight was recorded from the patient chart. Using the AiRDose estimated weights, hypothetical doses of epinephrine and lorazepam were calculated and compared with doses recommended via Broselow and to actual weight-based doses. Spearman rank correlation coefficients were calculated. We defined an acceptable difference of 20% between AiRDose and standard measurements as clinically relevant.
Five hundred forty-nine children (mean age, 4.8 years; standard deviation [SD], 2.9 years) were recruited. There were 99.6% of AiRDose lengths within a 20% difference of tape-measure lengths. There was a significant correlation between AiRDose and tape-measure length measurements (r = 0.989, P < 0.0001), and between AiRDose and Broselow weights (r = 0.983, P < 0.0001) and AiRDose and actual weights (r = 0.886, P < 0.0001). AiRDose lorazepam and epinephrine doses correlated significantly with Broselow lorazepam (r = 0.963, P < 0.0001) and epinephrine (r = 0.966, P < 0.0001) doses.
Anthropometric estimates and medication dose recommendations provided by AiRDose strongly correlate with established techniques. Further study will establish the feasibility of using AiRDose to accurately obtain weight estimates and medication doses for pediatric patients in the prehospital setting.
体重估计不准确是导致儿科急诊医疗差错的一个因素，尤其是在院前环境中。美国心脏协会目前的指南建议使用基于身长的体重估计工具，如布罗泽洛卷尺。我们开发了AiRDose智能手机应用程序，该程序利用增强现实技术提供基于身长的体重估计，以及药物剂量、除颤能量和设备尺寸建议；AiRDose被编程使用布罗泽洛换算来获得这些估计值。主要目的是比较AiRDose估计的身长与标准卷尺测量得到的实际身长。次要目的是将AiRDose估计的体重和关键药物剂量与当前既定方法进行比较。
在这项前瞻性验证研究中，使用AiRDose、布罗泽洛卷尺和标准卷尺，对就诊于2个急诊科的儿童进行身长和估计体重测量；从患者病历中记录实际体重。根据AiRDose估计的体重，计算肾上腺素和劳拉西泮的假设剂量，并与通过布罗泽洛推荐的剂量以及基于实际体重的剂量进行比较。计算斯皮尔曼等级相关系数。我们将AiRDose与标准测量值之间20%的可接受差异定义为具有临床相关性。
招募了549名儿童（平均年龄4.8岁；标准差[SD]为2.9岁）。99.6%的AiRDose测量身长与卷尺测量身长的差异在20%以内。AiRDose与卷尺测量身长之间存在显著相关性（r = 0.989，P < 0.0001），AiRDose与布罗泽洛体重之间（r = 0.983，P < 0.0001）以及AiRDose与实际体重之间（r = 0.886，P < 0.0001）也存在显著相关性。AiRDose的劳拉西泮和肾上腺素剂量与布罗泽洛的劳拉西泮（r = 0.963，P < 0.0001）和肾上腺素（r = 0.966，P < 0.0001）剂量显著相关。
AiRDose提供的人体测量估计值和药物剂量建议与既定技术密切相关。进一步的研究将确定在院前环境中使用AiRDose准确获得儿科患者体重估计值和药物剂量的可行性。
