Emergency Paediatric Weight Estimation ; Is it time to re-evaluate the western Broselow Tape for Indian children?
Authors: agrawal pranav , Samayam Purnima , S Mallige Ashish , Ravali R , K G Naveen 
Published: February 2025

Unlike in adults, drug dosages, infusion volumes, equipment sizes and even defibrillation energy is calculated based on the weight of the individual child. Weight estimation is, therefore, a crucial aspect of their rapid assessment and appropriate management, especially in the emergency setting. A significant stressor for the treating physician, presents as the need to know and promptly recall these individualized values in the critically ill child. In situations like severe illness, immobilization or an inability to stand/be placed on weighing scales, accurate weight measurement can become challenging.

An effective method for the rapid and accurate estimation of weight in these situations can be a valuable tool in safe and effective patient care. Most commonly used methods include crude visual estimation, age based formulae such as the Advanced Pediatric Life Support (APLS Formula) and Nelson formulae. Length based, color coded tools are also commonly used, the Broselow Tape being the most widely used, recommended by both the Indian Academy of Pediatrics(IAP) and also PALS Guidelines.

Unlike in adults, drug dosages, infusion volumes, equipment sizes and even defibrillation energy is calculated based on the weight of the individual child. Weight estimation is, therefore, a crucial aspect of their rapid assessment and appropriate management, especially in the emergency setting. A significant stressor for the treating physician, presents as the need to know and promptly recall these individualized values in the critically ill child. In situations like severe illness, immobilization or an inability to stand/be placed on weighing scales, accurate weight measurement can become challenging.

An effective method for the rapid and accurate estimation of weight in these situations can be a valuable tool in safe and effective patient care. Most commonly used methods include crude visual estimation, age based formulae such as the Advanced Pediatric Life Support (APLS Formula) and Nelson formulae. Length based, color coded tools are also commonly used, the Broselow Tape being the most widely used, recommended by both the Indian Academy of Pediatrics(IAP) and also PALS Guidelines.

The Broselow tape was found to overestimate the weights in our study population with a mean percentage error (MPE ±SD) of 10.68 ± 12.57. Based on Regression between estimated and actual weights (R2=9.179), we proposed a correction factor( - 8.21%) applied to the Broselow weight estimates, to subsequently re-allot into corrected weight bands. With this corrected weight band allocation, we were able to achieve a reduction in MPE (±SD) to 1.61 ± 11.55 and increased color zone agreement from 41.81% to 58.78%. We acknowledge some limitations of our study. This was a single-centre study, which may limit generalization of our findings. Secondly, we did not consider variables such as BMI which might influence weight estimation in both under- and overweight children.

To conclude, the Broselow Tape overestimates the weight in the Indian pediatric population leading to inaccurate weight band allocation. Our Proposed corrected broselow formula,with theapplied correction factor, significantly improved accuracy and color zone agreement.