A systematic review and meta-analysis of the accuracy of weight estimation systems used in paediatric emergency care in developing countries

INTRODUCTION: When weight cannot be measured during the management of medical emergencies in children, a convenient, quick and accurate method of weight estimation is required, as many drug doses and other interventions are based on body weight. Many weight estimation methodologies in current use have been shown to be inaccurate, especially in low- and middle-income countries with a high prevalence of underweight children. This meta-analysis evaluated the accuracy of weight estimation systems in children from studies from low- and middle-income countries. METHODS: Articles from low- and middle-income countries were screened for inclusion to evaluate and compare the accuracy of existing systems and the newer dual length- and habitus-based methods, using standard meta-analysis techniques. RESULTS: The 2D systems and parental estimates performed best overall. The PAWPER tape, parental estimates, the Wozniak method and the Mercy method were the most accurate systems with percentage of weight estimates within 10% of actual weight (PW10) accuracies of 86.9%, 80.4%, 72.1% and 71.4% respectively. The Broselow tape (PW10 47.1%) achieved a moderate accuracy and age-based estimates a very low accuracy (PW10 11.8–47.5%). CONCLUSIONS: The PAWPER tape, the Wozniak method and the Mercy method achieved an acceptable level of accuracy in studies from low- and middle-income countries and should preferentially be used and further advanced for clinical emergency medicine practice. Parental estimates may be considered if the regular caregiver of the child is present and a recent measured weight is known. The Broselow tape and age-based formulas should be abandoned in low- and middle-income country populations as they are potentially dangerously inaccurate.