Accuracy of Paramedic Broselow Tape Use

Posted by Patrick Lickiss on Apr 12, 2012 in Assessment, General, Research | 4 comments

The medical community has a love-hate relationship with the Broselow tape.  If you ask five providers, regardless of level of training, how accurate the device is, you are bound to get six answers.  The most recent report of the accuracy (or not) of the Broselow tape in estimating the weight of pediatric patients was e-published this month in the journal Prehospital Emergency Care.  Check out the abstract below:

Prehosp Emerg Care. 2012 Mar 23. [Epub ahead of print]

Accuracy of Paramedic Broselow Tape Use in the Prehospital Setting.

Heyming T, Bosson N, Kurobe A, Kaji AH, Gausche-Hill M.

Source

From the Department of Emergency Medicine, Harbor-UCLA Medical Center (TH, NB, AHK, MG-H) , Torrance , California ; St. Joseph’s Medical Center (TH) , Orange , California ; Los Angeles Biomedical Research Institute at Harbor-UCLA (TH, NB, AK, AHK) , Torrance , California ; Department of Medicine, David Geffen School of Medicine at UCLA (NB, AHK) , Los Angeles , California ; and University of California Irvine (AK) , Irvine , California .

Background: The Broselow tape is widely used to rapidly estimate weight and facilitate proper medication dosing in pediatric patients.

Objective: We aimed to determine the accuracy of prehospital use of the Broselow tape.

Methods: We prospectively enrolled a consecutive sample of pediatric patients transported to the emergency department (ED) at Harbor-UCLA Medical Center from February 2008 to January 2009. Eligible subjects arrived via ambulance and were less than 145 cm tall, the upper limit of height for Broselow measurements. Subjects were excluded if they had a medical condition preventing proper measurement (e.g., contractures). Per Los Angeles County protocol, paramedics obtained a Broselow weight on all pediatric patients. The paramedic Broselow weight was compared with the ED Broselow weight and the ED scale weight, which was obtained unless mobilization was contraindicated. Accuracy was determined by assessing Bland-Altman plots and the Pearson correlation coefficient. As part of a sensitivity analysis, multiple imputation was used to account for missing data.

Results: There were 572 subjects enrolled. The median age was 24 months (interquartile range [IQR] 10 to 49 months); 316 (55%) of the subjects were male. The weighted Cohen’s kappa assessing agreement between the paramedic and ED Broselow colors was 0.74 (95% confidence interval [CI] 0.68 to 0.79). The median difference between the paramedic Broselow weight and the scale weight was -0.10 kg (IQR -1.7 to 0.7). The accuracy of the paramedic Broselow weight when compared with the ED scale weight and the ED Broselow weight as defined by Pearson’s correlation coefficient was 0.92 (95% CI 0.90 to 0.93) and 0.97 (95% CI 0.97 to 0.98), respectively. Multiple imputation for missing data did not alter the results.

Conclusion: Paramedic Broselow weight correlates well with scale weight and ED Broselow weight. Paramedics can use the Broselow tape to accurately determine weight for pediatric patients in the prehospital setting.

This appears to be a fairly well designed study.  Comparing paramedic Broselow weights to those obtained both from the hospital scale and the hospital Broselow allows both the technique used by the prehospital providers as well as the accuracy of the tape itself to be analyzed.

Do you routinely use the Broselow in your practice?  Do you have a different technique for estimating the weight of pediatric patients? Any tips or tricks?  Let me know in the comments.

Image via Flickr