Accuracy of Paediatric Advanced Weight Prediction in the Emergency Room-eXtra Length (PAWPER XL) Tape in Estimation of Body Weight in Pediatric Emergencies.

Background Accurate weight estimation in pediatric emergencies is essential for safe drug dosing and equipment sizing. Traditional tools like the Broselow tape often lack precision in children with diverse body habitus. The Paediatric Advanced Weight Prediction in the Emergency Room - eXtra Length (PAWPER XL) tape, which incorporates both length and body habitus, has been proposed to improve estimation accuracy. This study aimed to evaluate the accuracy of the PAWPER XL tape compared to the Broselow tape among children admitted to a pediatric intensive care unit (PICU) in a resource-constrained setting. Methods A cross-sectional observational study was conducted at the PICU of Kamineni Institute of Medical Sciences, Narketpally, Telangana, from August 2022 to May 2024. One hundred children aged 3 months to 12 years were enrolled. Demographic and anthropometric data were recorded, and weight was estimated using both PAWPER XL and Broselow tapes. Accuracy was assessed using the proportion of estimates within 10% (PW10) and 20% (PW20) of actual weight, mean percentage error (MPE), and Bland-Altman 95% limits of agreement. Subgroup analyses were conducted based on weight categories and BMI-for-age Z-scores. McNemar's test and Fisher's exact test were used, with significance set at p<0.05. Results The PAWPER XL tape demonstrated significantly higher accuracy, with 83.5% of estimates within 10% (PW10) and 98.7% within 20% (PW20) of actual weight, compared to 61.2% and 87.9%, respectively, for the Broselow tape (χ² = 18.452, p < 0.001). PAWPER XL also showed lower bias (MPE: +1.2% vs. -1.6%) and narrower limits of agreement. Subgroup analysis confirmed its consistent accuracy across all weight and BMI-for-age categories, including underweight (PW10 = 69.4%), average (PW10 = 89.1%), and overweight (PW10 = 70.5%) children, while Broselow accuracy declined significantly in non-average habitus, especially overweight children (PW10 = 9.8%). Conclusion The PAWPER XL tape is a more accurate and clinically reliable tool for pediatric weight estimation in emergency settings compared to the Broselow tape. Its consistent performance across varying body types and its applicability in resource-limited settings like India underscore its value in improving pediatric emergency care outcomes.