Estimation of lean body weight in children for drug dose calculation - PROJECT SUMMARY Children with obesity are at increased risk for dose-related medication errors during emergency care, when compared to children with healthy weight. Inaccurate weight estimates or the use of incorrect dosing scalars are the most important cause of these errors. Ideally, estimates of both total body weight and lean body weight should be available for calculation of lipophilic and hydrophilic drug doses, respectively. This is a critical safety issue. The PAWPER XL-MAC tape is a well-studied device, designed for weight estimation in pediatric emergencies. However, the tape has suboptimal accuracy in estimating total body weight in children with obesity. It also needs to be upgraded to provide estimates of lean body weight in addition to total body weight to facilitate optimum drug dose calculations in children with obesity. The goal of this project is to upgrade the PAWPER XL-MAC tape, to be accurate and reduce the risk of potentially harmful dosing errors in the treatment of pediatric patients. The central hypothesis in this project is that the PAWPER XL-MAC tape system can be modified to improve the accuracy of TBW estimates in children with obesity and to provide accurate estimations of LBW in children and adolescents. This hypothesis will be tested by pursuing three specific aims: (1) Assemble two large datasets for the secondary analysis; (2) Recalibrate the existing TBW estimates produced by the PAWPER XL-MAC tape in children with obesity; and (3) Develop and validate a model to estimate LBW in children using the PAWPER XL-MAC tape. Important secondary aims will be to extend the PAWPER XL-MAC tape to ensure all adolescents can receive a weight estimate, and to investigate the relationship between IBW standards and measured LBW in children and adolescents. Our aims will be addressed in two database studies. Firstly, we will pool datasets from the National Health and Nutrition Examination Surveys from 1999-2000 to the present (33,683 children and adolescents), and a validated dataset of 2,434 pooled nutritional anthropometric surveys from 51 low- and middle-income countries (1,717,172 children). In the first study we will recalibrate the existing TBW estimates of the PAWPER XL- MAC tape in children with obesity and severe obesity to enhance its accuracy. We will also extend the length of the tape to ensure it can provide weight estimations for adolescents. In the second study, we will develop a model to estimate LBW using recumbent length and MAC as input variables. We will also investigate the relationship between IBW standards and measured LBW in children. We will use methodology that we have previously devised in the development of the pediatric and adult versions of the tape. The proposal is relevant to the NICHD’s mission of leading research and training to enhance the lives of children and adolescents. In this proposal, the focus on prioritization of patient safety in a patient group already at high risk of poor outcomes from acute illness or injury, is faithful to that mission.
