Development and validation of a novel paediatric weight estimation equation in multinational cohorts of sick children.

AIM: In sick children who are unable to be weighed estimation of weight is often required, but the routinely used equations lack accuracy and precision. This study aimed to develop a novel equation (Children's European Estimator of Weight-CEEW) using measurements of mid-upper arm circumference (MUAC) and other predictors in multinational groups of sick children in Europe. METHODS: Weight estimation equations were developed in 2086 children from the UK, Greece and the Netherlands, using a combination of demographics, MUAC and height measurements. The final CEEW equations were compared against the performance of the European Resuscitation Council (ERC), Advanced Paediatric Life Support (APLS) and the Cattermole equations. RESULTS: Two final CEEW equations were developed, incorporating measurements of age, gender and MUAC, with (CEEW1) or without (CEEW2) the inclusion of height. Both equations presented very high coefficients of determination (R2>96.5%), minimal mean prediction error and narrower limits of agreement than the comparator equations. 88% (CEEW1) and 77% (CEEW2) of weight estimates fell within 15% of measured body weight. These figures compared with less than 57%, 57% and 37% for the ERC, APLS and Cattermole equations respectively. CONCLUSION: The CEEW equations performed substantially better than other routinely used equations for weight estimation. An electronic application for mobile use is presented.

Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 3: Management of paediatric minor head injuries: safe discharge?

A short-cut review was carried out to establish whether the finding of a normal cranial CT scan, in a child with a history of minor head injury, a Glasgow coma scale (GCS) score of 15 and normal neurological examination could facilitate safe discharge from hospital. Ninety-eight articles were found using the reported search and a further two papers were found from the references of selected papers. A total of 11 trials were included with one prospective cohort study including 13,543 patients. The authors, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated (table 3). It is concluded that in the absence of any coagulation problems, a child who presents following a minor head injury with a GCS of 15, normal neurological examination and a normal CT scan can be safely discharged to the care of a capable parent.