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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 19  |  Issue : 1  |  Page : 20-23

Is the Broselow Tape and APLS formula applicable to Nigerian children? The Kano experience


Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University Kano, Kano, Nigeria

Date of Web Publication17-Dec-2015

Correspondence Address:
Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Nigeria
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DOI: 10.4103/1119-0388.172055

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  Abstract 

Background: Weight estimation is useful in pediatric practice; it is used in drug dosage calculation and for nutritional assessment. However, in comatose children actual weight measurement may not be possible therefore weight estimation becomes imperative. The Advanced Pediatric Life Support (APLS) formula and the Broselow Tape have been validated in most developed countries, but not in Nigerian children. Objective: To determine the performance of APLS formula and Broselow Tape in Nigerian children. Materials and Methods: The actual weight of 300 children in the Pediatric Emergency Unit and the Outpatient Department of Aminu Kano Teaching Hospital were taken using weighing scales and their length was also taken; these were compared with values estimated from their ages using the APLS formula and the Broselow Tape. Results: Both methods had similar pattern of performance, underestimating weight (39.7%) in the 1-year age group, and overestimation in the older age groups; however, these were within 95% limit of agreement. The overall average percentage difference was 5.3% and 5.4% for the Broselow Tape and APLS formula, respectively. The proportion of agreement within 10% of the actual weight were 36.8%, 48.8%, 64.3%, 48.1%, and 54.1% for 1, 2, 3, 4, and 5-year age groups, respectively. Conclusion: Both methods are of benefit in Nigerian children, although they underestimated weight in children within the 1-year-age-group.

Keywords: APLS formula, Broselow Tape, children, Nigeria


How to cite this article:
Aliyu I, Abdulsalam M. Is the Broselow Tape and APLS formula applicable to Nigerian children? The Kano experience. Trop J Med Res 2016;19:20-3

How to cite this URL:
Aliyu I, Abdulsalam M. Is the Broselow Tape and APLS formula applicable to Nigerian children? The Kano experience. Trop J Med Res [serial online] 2016 [cited 2019 Jul 18];19:20-3. Available from: http://www.tjmrjournal.org/text.asp?2016/19/1/20/172055


  Introduction Top


Weight estimation is vital in pediatric care, especially in clinical states where interruption for actual weight measurement may be difficult, such as as in resuscitation of critically-ill children or when functional weighing scales are not available, as experienced in some rural health facilities in developing countries. However, health care professionals should adopt proper technique of weight measurement in order to avoid unnecessary errors. Various estimation formulae [1],[2],[3],[4],[5],[6] have been developed, with varied outcome in different populations; the Advanced Pediatric Life Support (APLS) formula has been used over the years in estimating weight of Nigerian children but its accuracy has not been validated in our population to the best of our knowledge and the use of the Broselow Tape is still new in most resource limited settings, therefore establishing their accuracy will alleviate constraints in weight estimation during pediatric emergency care. This study hopes to establish the usefulness and validity of these methods among the children seen in our health facility.


  Materials and Methods Top


This was a cross sectional analysis of children aged 0-5 years seen from May-July 2014 in the Pediatric Outpatient Department and Pediatric Emergency Unit of Aminu Kano Teaching Hospital, Kano. A systematic random sampling method was adopted to select the required sample size. Weight and length of subjects were measured and recorded in a proforma; while the weight estimation from the Broselow Tape based on the color code was done; and finally the weight was estimated using the APLS formula (age x 0.5) +4 for those less than one – year and (2x age) +8[7] for those more than 1 year old.

Approval for the study was obtained from the Ethics Committee of Aminu Kano Teaching Hospital, and consent obtained from the parents/caregivers. Children ages 0-5 years old were recruited for this study, while parents who declined consent and those whose weighing or length taking was difficult were excluded.

Data analysis

Statistical Package for Social Sciences version 19 (SPSS Inc., Chicago, USA) software was used to analyze this data. Variables were summarized using mean and standard deviation and frequency distribution.


  Results Top


Three hundred children were recruited for this study; there were 177 (59.0%) males and 123 (41.0%) females, with a male-to-female ratio of 1.4:1. The age groups were: 125 (41.7%) in the 1-year-old group, 82 (27.3%) in the 2-year-old group, 42 (14.0%) in the 3-year-old group, 27 (9.0%) in the 4-year-old group, and 24 (8.0%) in the 5-year-old group.

Estimate of bias

The estimate of the bias showed underestimation in the younger age groups using both Broselow Tape and the APLS formula. The bias were more with Broselow Tape in the 1-year-old group but the Broselow performed better in the older age groups [Table 1].
Table 1: Estimate of bias for both methods

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Bland-Altman Plot

The plot for APLS formula [Figure 1] showed underestimation in the younger age groups and overestimation by the formula in the older age groups with scanty outliers, though most were within the 95% of the upper and lower limits of agreement. Similarly the Broselow Tape [Figure 2] underestimated the weight in the younger age groups, with more scatters in the older age-group and it also had more outliers.
Figure 1: Bland-Altman plot for the APLS formula method

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Figure 2: Bland-Altman plot for the Broselow Tape method

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Percentage difference for both methods

[Table 2] shows that both methods had similar pattern of performance with poor performance in the 1-2 year age groups while it was better in the older age groups; the best performance was recorded in the 3-year old age group. However, both methods underestimated the actual weight in 39.7% of the subjects and the overall average percentage difference was 5.3% and 5.4% for the Broselow Tape and APLS formula, respectively. The mean percentage difference was lower in the younger age groups for both methods and higher in the older age groups.
Table 2: Mean percentage difference of both methods for the different age groups

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[Table 3] shows that agreement was higher in the older age groups with both methods.
Table 3: Proportion of agreement within 10% of the actual weight for both methods

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  Discussion Top


The Broselow Tape is still new in many health centers in Nigeria, but the APLS formula has been in use; however, this formula has witnessed changes over the years from an initial (age + 4) ×2 to now three sets of formulae: (age x0.5) +4 for those less than 1-year; (2x age) +8 for 1-5 years; and (3 × age) +7 for 6-12-years.[7] This may be cumbersome and easily forgettable especially among community health workers. For ease of estimation, some health workers had used parental estimation of their children's weight [8] but this is not practicable in our setting where the literacy level is still low. Though APLS formula has been used over the years in weight estimation in emergency resuscitation, there are concerns of its global application with varied results recorded in some settings. Therefore, in resource poor settings where malnutrition is high, using parameters established for children in developed countries may possibly result in weight overestimation. Therefore, researchers have compared several weight estimation methods in their indigenous population [4],[9],[10],[11],[12],[13] and some have therefore developed their indigenous weight estimation methods.[14]

Both the Broselow Tape and APLS formula underestimated the actual weight in children less than 1 year with an overall percentage underestimation of 39.7% in this study. Although this was higher than that documented by Luscombe et al.,[15] it was not clinically significant because the mean differences (bias) were quite small when compared to that of Varghese et al.[16] in India. However, the Broselow Tape performed better than the APLS formula with lesser mean bias and the overall percentage difference was higher than that reported by House et al.[6] among Kenyan children (-2.2% and -5.2% for Broselow and APLS respectively). Therefore, the Broselow Tape and APLS formula performed significantly well that should warrant their recommendation among children in Kano, Nigeria. These methods of weight estimation may come handy in rural settings where appropriate weighing scales may not be readily available.


  Conclusion Top


The Broselow Tape and APLS formula provide efficient estimates of weight of Nigerian children with less underestimation in those of the 2 to 5 years age-groups; therefore, they are of benefit during resuscitation especially for fluid and drug dosage calculations when measuring the actual weight may not be practicable. However, these are not replacements for actual weight measurement, therefore, effort should be made to measure the actual weight as soon as it is possible.

 
  References Top

1.
Black K, Barnett P, Wolfe R, Young S. Are methods used to estimate weight in children accurate? Emerg Med (Fremantle) 2002;14:160-5.  Back to cited text no. 1
    
2.
Garland JS, Kishaba RG, Nelson DB, Losek JD, Sobocinski KA. A rapid and accurate method of estimating body weight. Am J Emerg Med 1986;4:390-3.  Back to cited text no. 2
[PUBMED]    
3.
Nieman CT, Manacci CF, Super DM, Mancuso C, Fallon WF Jr. Use of the Broselow tape may result in the underresuscitation of children. Acad Emerg Med 2006;13:1011-9.  Back to cited text no. 3
    
4.
Wells M, Coovadia A, Kramer E, Goldstein L. The PAWPER tape: A new concept tape-based device that increases the accuracy of weight estimation in children through the inclusion of a modifier based on body habitus. Resuscitation 2013;84:227-32.  Back to cited text no. 4
    
5.
Ali K, Sammy I, Nunes P. Is the APLS formula used to calculate weight-for-age applicable to a Trinidadian population? BMC Emerg Med 2012;12:9.  Back to cited text no. 5
    
6.
Greig A, Ryan J, Glucksman E. How good are doctors at estimating children's weight? J Accid Emerg Med 1997;14:101-3.  Back to cited text no. 6
    
7.
Resuscitation Guideline. APLS Update 2013. Available from: http://www.mededcoventry.com/Courses/Booking/APLS%20update%20booklet%202013.pdf. [Last accessed on 2014 Jul 10].  Back to cited text no. 7
    
8.
Krieser D, Nguyen K, Kerr D, Jolley D, Clooney M, Kelly AM. Parental weight estimation of their child's weight is more accurate than other weight estimation methods for determining children's weight in an emergency department? Emerg Med J 2007;24:756-9.  Back to cited text no. 8
    
9.
Dicko A, Alhousseini ML, Sidibé B, Traoré M, Abdel-Rahman SM. Evaluation of the Mercy weight estimation method in Ouelessebougou, Mali. BMC Public Health 2014;14:270.  Back to cited text no. 9
    
10.
House DR, Ngetich E, Vreeman RC, Rusyniak DE. Estimating the weight of children in Kenya: Do the Broselow tape and age-based formulas measure up? Ann Emerg Med 2013;61:1-8.  Back to cited text no. 10
    
11.
Luscombe MD, Owens BD, Burke D. Weight estimation in paediatrics: A comparison of the APLS formula and the formula 'Weight = 3(age)+7'. Emerg Med J 2011;28:590-3.  Back to cited text no. 11
    
12.
Erker CG, Santamaria M, Moellmann M. Size does matter--age-related weight estimation in “tall n' thin” and “tiny n' thick” children and a new habitus-adapted alternative to the EPLS-formula. Resuscitation 2014;85:1174-8.  Back to cited text no. 12
    
13.
Seddon C, Lockitt L, Dhanjal S, Eisenhut M. Validation of advanced paediatric life support formulas for weight calculation in a multiethnic population. ISRN Pediatr 2012;2012:869634.  Back to cited text no. 13
    
14.
Ali K, Sammy I, Nunes P. Is the APLS formula used to calculate weight-for-age applicable to a Trinidadian population? BMC Emerg Med 2012;12:9.  Back to cited text no. 14
    
15.
Luscombe M, Owens B. Weight estimation in resuscitation: Is the current formula still valid? Arch Dis Child 2007;92:412-5.  Back to cited text no. 15
    
16.
Varghese A, Vasudevan VK, Lewin S, Indumathi CK, Dinakar C, Rao SD. Do the length-based (Broselow) tape, APLS, Argall and Nelson's formulae accurately estimate weight of Indian children? Indian Pediatr 2006;43:889-94.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]


This article has been cited by
1 The accuracy of emergency weight estimation systems in children—a systematic review and meta-analysis
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International Journal of Emergency Medicine. 2017; 10(1)
[Pubmed] | [DOI]
2 The accuracy of the Broselow tape as a weight estimation tool and a drug-dosing guide – A systematic review and meta-analysis
Mike Wells,Lara Nicole Goldstein,Alison Bentley,Sian Basnett,Iain Monteith
Resuscitation. 2017; 121: 9
[Pubmed] | [DOI]
3 A systematic review and meta-analysis of the accuracy of weight estimation systems used in paediatric emergency care in developing countries
Mike Wells,Lara Nicole Goldstein,Alison Bentley
African Journal of Emergency Medicine. 2017;
[Pubmed] | [DOI]



 

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