The PAWPER tape as a tool for rapid weight assessment in a Paediatric Emergency Department: Validation study and comparison with parents' estimation and Broselow tape.

Aim: To validate the PAWPER tape and assess its inter-observer reliability in children accessing a Paediatric Emergency Department (PED). As secondary outcome we compared the accuracy of the PAWPER tape with that of parents' estimation, the Broselow tape and the European Paediatric Life Support (EPLS) formula. Methods: This was a cross-sectional study of children (0-12 years) enrolled in a tertiary Paediatric Emergency Department in Italy. Children's weight was estimated by parents and by trained healthcare providers using the PAWPER tape, the Broselow tape and the EPLS formula. The root mean squared percentage error (RMSPE) for the estimation of precision was calculated. Overall accuracy was evaluated using the percentage of weight estimation falling within 10% (PW10) and 20% (PW20) of real weight. Results: The study included 2060 children. Parental estimation was the most accurate and precise method. The PAWPER tape was accurate throughout all habitus sizes except for extreme underweight and overweight categories. Furthermore, it was more accurate and more precise than the Broselow tape and the EPLS formula (p adjusted <0.001). Conclusions: The PAWPER tape served as an accurate method for weight estimation in children accessing a Paediatric Emergency Department, with excellent inter-rater reliability. It performed significantly better than other length or age-based tools, showing good accuracy and precision except for very extreme weights. Whilst parents' estimation yielded to be the most accurate and precise method, the age-based EPLS formula was not reliable for estimating weight in all subcategories of habitus.

Prevalence of antinuclear antibodies in schoolchildren during puberty and possible relationship with musculoskeletal pain: a longitudinal study.

OBJECTIVE: The role of antinuclear antibodies (ANA) in children has still to be elucidated. The aim of our study was to evaluate the prevalence and persistence of ANA in schoolchildren during the puberty switch, and the possible relationship with chronic noninflammatory musculoskeletal pain (MSP). METHODS: Children aged 8-13 years and attending 4 public schools underwent a clinical examination, focusing on pubertal stage and presence of chronic noninflammatory MSP. Laboratory tests to determine the autoantibody-profile were also performed. Subjects with ANA positivity (titer ≥ 1:80) and/or chronic noninflammatory MSP were re-evaluated 3 years later. RESULTS: Two hundred sixty-one subjects enrolled in the study and 12.3% were ANA-positive, equally distributed in terms of sex and pubertal status. Three years later, in the group of patients studied for chronic noninflammatory MSP (n = 67), ANA positivity significantly increased from 13.4% to 44.8%. In the ANA-positive cohort at baseline (n = 28), 92.9% of subjects were confirmed as being ANA-positive with a significantly increased titer. No association between ANA positivity and chronic noninflammatory MSP was found. CONCLUSION: ANA prevalence and titers increase during puberty, especially in females, but have no relationship with chronic noninflammatory MSP. This finding may be related to the complex hormonal changes during the puberty switch period and opens new insights into autoimmunity.

Scleroderma in children: an update.

PURPOSE OF REVIEW: Scleroderma, in its localized and systemic presentation, represents the third most frequent rheumatic condition in childhood after juvenile idiopathic arthritis and systemic lupus erythematosus. Early diagnosis, appropriate assessment and effective treatment are crucial to improve the long-term outcome. RECENT FINDINGS: Recent studies, concerning histopathology and clinical associations with other conditions, open new horizons on the etiopathogenesis of scleroderma. New developments have been also reached in the field of outcome measures. In juvenile localized scleroderma (JLS), new techniques such as Doppler and laser Doppler imaging have shown their usefulness for the daily monitoring of the patients. In juvenile systemic sclerosis (JSSc), a new severity score has been developed and needs to be validated in future trials. Finally, a randomized, double-blind controlled trial, a multicenter consensus statement and long-term follow-up studies have confirmed the important role of methotrexate (MTX) for the treatment of JLS. SUMMARY: Studies over recent years highlighted the role of imaging as outcome measures for JLS and introduced a severity score for JSSc. New studies on MTX confirmed its important role for the treatment of JLS.