Is weight just a number? The accuracy of UK ambulance paediatric weight guidance – findings from a cross-sectional study

BACKGROUND: The weight of children provides the cornerstone of their clinical management, as many drug dosages, equipment sizes, fluid boluses, as well as DC shock energy, are administered on a per kilogram basis. Children who attend hospital are weighed using scales prior to receiving these interventions. This is not possible in the pre-hospital environment. A paucity of evidence exists to support the page for age weight guidance indicated by JRCALC, and it remains unknown if this approach meets the reference standard of 70% of estimations within 10% of actual weight and 95% within 20% of actual weight. METHODS: We used a cross-sectional study design and collected data from a convenience sample of children who attended the outpatients department of a major hospital in England between July and September 2019. All children aged between 1 and 11 years who were weighed were eligible for inclusion. Outcomes were to determine if the page for age approach meets the reference standard and to determine any implications for care. RESULTS: 341 children were included in this study. Each age group consisted of varying numbers of children. 50.5% (172/341) of the sample were female. Observed weights ranged from 8.28 to 82.70 kg (median 20.60 kg). The mean weight of girls versus boys was 24.69 kg and 23.39 kg respectively (95% CI -4.12–1.32, p = 0.3123). Observed weights were greater than the page for age guidance weight in all age groups, and the accuracy of page for age weight guidance diminished with age. Adrenaline 1:10,000 doses and defibrillation energy levels guided by page for age differ from those guided by weight, but are not deleterious to care. CONCLUSION: Page for age weight guidance does not meet the reference standard. Most paediatric pre-hospital care is administered by age and not weight. In the absence of an accurate weight, ambulance clinicians should continue to use the page for age system, although the gold standard remains to use an accurate weight measurement. While there are no facilities to weigh children in ambulances, if an accurate weight is available then consideration should be given to using this rather than age.