Each HS corresponds to a predicted weight within each length segment of the tape, which can be read off by the user. An HS of 1 would represent an underweight child, an HS of 3 a normal-weight child, an HS of 5 an obese child, and an HS of 7 a severely obese child. Using a card with reference images for guidance, the user assigns an HS from 1 to 7 for the child. The child’s weight estimate can be adjusted up or down from “normal weight” based on their body habitus using the HS system. The length segment on the tape where the child’s heel crosses the tape is then used for the weight estimation. The tape is placed alongside the child, with the start of the tape aligned to the top of the child’s head. The PAWPER XL tape system is also a dual length- and habitusbased method of weight estimation ( Fig. Recently, this method is one of the most accurate pediatric weight estimation methods in the world. These measurements are used to identify ‘partial weights’ from a table (one for the humeral length and one for the MAC) which are added together to obtain the weight estimation. Measurements are taken of the child’s humeral length and MAC using a regular anthropometric tape. The Mercy method is a dual length- and habitus-based method of weight estimation. The Broselow tape can only provide weight estimations in children less than 143 cm in length. The weight estimation can then be read directly off the tape at the length where the heel crosses the tape. It is used by laying the tape alongside the child and aligning the start of the tape with the top of the child’s head. The Broselow tape is a length-based tape (which includes precalculated drug doses) and is one of the most studied weight estimation methods worldwide. Weight estimation methods evaluated in this study The secondary aim was to compare the performance of these methods with that of the Mercy method and the Broselow tape (as a past reference standard). With the above background, the primary aim of this study was to evaluate the weight estimation accuracy and time to obtain weight estimation for the PAWPER XL tape and the PAWPER XL-MAC method of children from a low socioeconomic background. Preliminary validation studies conducted from datasets of anthropometric data have shown the excellent accuracy of the PAWPER XL-MAC system, on par with the regular PAWPER XL tape, but no prospective studies have yet evaluated this method. However, measuring MAC might take longer to produce a weight estimate, which would not be ideal during emergency care. Since MAC has previously been shown to be strongly associated with body habitus and is an objective measurement, as opposed to an observer’s impression of a patient, its use may increase the accuracy of the PAWPER XL-MAC system when compared to the original system. For this reason, the PAWPER extra-long (XL)-MAC system was developed, which makes use of MAC to define body habitus, rather than a gestalt impression. This system is potentially vulnerable to error as different health care workers may have different perceptions of body habitus. The PAWPER tape system makes use of a child’s body length and a general impression (gestalt visual assessment system) or a figural reference image rating scale (using pictures of children at each habitus score ) to assess habitus and provide a weight estimation from the tape. This method has been shown to have good accuracy in populations with a high prevalence of obesity or of underweight children. The Mercy method uses surrogates of the total body length (humeral length) and body habitus (mid-arm circumference, MAC) to estimate weight. Other than parental estimates, the most accurate current methods of weight estimation are the newer two-dimensional dual length- and body habitus-based systems, such as the Mercy method and the pediatric advanced weight prediction in the emergency room (PAWPER) tape system. This can potentially lead to a dangerous degree of drug overdosing or underdosing. Many studies have shown that the Broselow tape overestimates children’s weights in lower socioeconomic settings and underestimates the weight of children from higher income countries. However, it also has significant disadvantages. This tape is commonly used in the emergency setting because of its simplicity and immediate availability of medication dosages and equipment sizes. Various length-based weight prediction methods have been developed for children in the past, the most well-known of which is the Broselow tape. As the estimated body weight determines the efficacy and safety of therapeutic interventions, this estimation needs to be accurate. This is either due to the need for immediate intervention and resuscitation or due to immobilization. The actual body weight of children presenting in emergency settings or receiving critical care is often difficult or impossible to obtain. The management directed at children is generally quantified by their body weight.
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