![]() Necessary changes to the operating manual identified by this process were completed between iterations. Abstractors completed an iterative inter-rater reliability process in which each abstractor abstracted variables for 10 randomly selected charts and any discrepancies were analyzed by TH, PKP, and CKR. Abstractors were trained research assistants who followed a standardized operating manual for data abstraction (including instructions regarding where each variable may be found in the chart). ![]() Patients with cerebral palsy and contractures were excluded, as were any interfacility transports (including transports from skilled nursing facilities), patients for whom ED weights were not obtained using a scale, and patients whose charts contained incomplete study data. Scale-based weight from the ED was used as the standard for comparison.Īll patients transported via EMS to the study institution for the duration of the study were included unless they met exclusion criteria. Prehospital weight estimation method was based on EMS provider policy and statistics were calculated based on an intention to treat model. Demographics, EMS provider, prehospital weight estimation, prehospital medication/dose, ED weight, ED intubation status, and ED disposition were collected. Data were collected via retrospective chart review of ED records by a team of trained data abstractors using a standardized REDCap (Vanderbilt University Nashville, Tennessee USA) data collection form. This retrospective cohort study included trauma and non-trauma pediatric patients transported via Emergency Medical Services (EMS) to the ED of a Level 2 trauma center/Comprehensive Children’s Receiving Center from Januthrough June 30, 2021. Secondary objectives included evaluating accuracy of medication dosing, the percentage of patients placed in accurate weight categories using the Broselow method, and comparing ED weight by age to predicted Handtevy weights. The primary objective of this study was to assess the field performance of the Broselow tape and the Handtevy method with respect to prehospital pediatric patient weight estimations. 12, 17, 22 There appear to be no studies in the published literature evaluating the accuracy of the Handtevy weight estimation method in the prehospital setting. 21 There are few studies evaluating the Handtevy system, most of which were published prior to the development of the solely age-based application, however Rappaport, et al recently published a manuscript reporting almost 90% dosing accuracy using the Handtevy Field Guide (accuracy was based on correct use of the field guide/patient age, not patient weight). The Handtevy system, initially developed in 2010 as a length and age-based system, has been adapted and can now be used as an exclusively age-based tool for weight estimation. The Broselow method was developed in the 1980s and has been modified and studied fairly extensively in the intervening years, with varying results. 5 The Broselow method, which provides a weight estimation based on length as measured using the Broselow tape, is the most commonly used length-based tape. Many tools have been developed to assist with pediatric weight estimation, including age-based formulas, length-based tapes, paperboard dosing wheels, and electronic applications. However, in prehospital care, obtaining reliable weight measurements is not straightforward it is estimated that approximately 20% of out-of-hospital pediatric weight estimates are not accurate. As pediatric medication dosing is predominantly weight-based, accurate assessment is essential. 1 Many of the complications inherent to pediatric medication dosing are potentiated by the unpredictable nature of the prehospital setting. Pediatric medication errors have been attributed to a number of causes, including weight-based dosing and the increased number of calculations required for correct dosing and administration. 2– 4 These errors are estimated to affect over 21,000 US children under the age of 11 each year. 1 Medication errors have been shown to occur more frequently in the emergency department (ED), and error rates rise even further in the prehospital setting to just under 35% for all medications and over 60% for epinephrine. In the pediatric in-patient setting, Kaushal, et al reported an error rate of approximately 55 errors for every 100 admissions, the majority (28%) being dosing errors, and a potential adverse drug event rate of 10/100 admissions. Medication errors in the pediatric patient population are quite prevalent.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |