Pediatric Dietetic Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Lyon-Bron, France.
Public Health Department, Clinical Epidemiology and Research Unit, Hospices Civils de Lyon, 59 Bd Pinel, 69500, Lyon-Bron, France.
Eur J Pediatr. 2024 Oct;183(10):4275-4286. doi: 10.1007/s00431-024-05692-3. Epub 2024 Jul 25.
In hospitalized children, height should be measured. When world health organization (WHO) height measurement gold standards is impossible, the ideal height estimation technique is still unclear. We conducted an international prospective study in eight different pediatric intensive care units to assess the accuracy, precision, practicability, safety, and inter-rater reliability of 12 different height estimation techniques, based on body segment measurement extrapolation, or other calculations using previous or projected heights. All extrapolation techniques were performed on each child, and later compared to their WHO gold standard heights. A total of 476 patients were enrolled. In the < 2-year subgroup, board length use and growth chart extrapolation performed best. In the ≥ 2-year subgroup, growth chart extrapolation and parents' report were the most accurate, followed by height measurement alongside the body with a tape measure. In both groups, body segment extrapolations were poorly predictive and showed mean bias and limits of agreement that varied a lot with age. Most body segment-based techniques presented with frequent measurement difficulties, but children's safety was rarely compromised. The inter-rater reliability of body segment measurement was low in the < 2-year subgroup.Conclusions: To accurately estimate height in hospitalized children, health care professionals should integrate the accuracy, precision, practicability, and reliability of each measurement technique to select the most appropriate one. Body segment-based techniques were the least accurate and should probably not be used. Simple techniques like growth chart extrapolation, or measurement alongside the body (and length board measurement in the youngest) should be implemented in daily practice.Trial Registration: The study protocol was registered (12 April 2019) on the clinical-trial.gov website (NCT03913247).
在住院的儿童中，应测量身高。当无法采用世界卫生组织（WHO）身高测量金标准时，理想的身高估计技术仍不明确。我们在 8 个不同的儿科重症监护病房进行了一项国际前瞻性研究，评估了基于身体节段测量外推或使用以前或预计的身高进行其他计算的 12 种不同身高估计技术的准确性、精密度、实用性、安全性和组内相关性。对每个儿童均进行所有外推技术，然后将其与 WHO 金标准身高进行比较。共有 476 名患者入组。在<2 岁亚组中，板长使用和生长图表外推的效果最佳。在≥2 岁亚组中，生长图表外推和父母报告最为准确，其次是使用卷尺沿身体测量的身高。在这两个年龄组中，身体节段外推的预测性均较差，且平均偏差和一致性界限随年龄变化很大。大多数基于身体节段的技术存在频繁的测量困难，但儿童的安全性很少受到影响。在<2 岁亚组中，身体节段测量的组内相关性较低。结论：为了准确估计住院儿童的身高，医护人员应整合每种测量技术的准确性、精密度、实用性和可靠性，选择最合适的技术。基于身体节段的技术准确性最低，可能不适合使用。在日常实践中，应实施简单的技术，如生长图表外推或沿身体测量（对于最小的儿童，可使用板长测量）。试验注册：该研究方案于 2019 年 4 月 12 日在临床研究.gov 网站（NCT03913247）上注册。
