CORKSCREW 2013 CORK study of children's realistic estimation of weight.

BACKGROUND: In a resuscitation situation involving a child (age 1-15 years) it is crucial to obtain a weight as most interventions and management depend on it. The APLS formula, '2×(age+4)', is taught via the APLS course and is widely used in Irish hospitals. As the prevalence of obesity is increasing the accuracy of the formula has been questioned and a newer formula has been suggested, the Luscombe and Owens (LO) formula, '(3×age)+7'. AIMS AND OBJECTIVES: To gather data on the weights and ages of the Cork paediatric population (ages 1-15 years) attending services at the Cork University Hospital (CUH), and to identify which of the two age-based weight estimation formulae has best diagnostic accuracy. SETTING: CUH, Ireland's only level one trauma centre. METHODS: Retrospective data collection from charts in the Emergency Department, Paediatric Assessment Unit and the Paediatric wards of CUH. RESULTS: 3155 children aged 1-15 years were included in the study. There were 1344 girls and 1811 boys. The formula weight='2×(age+4)' underestimated children's weights by a mean of 20.3% (95% CI 19.7% to 20.9%) for the ages of 1-15 years. The LO formula weight='(3×age)+7' showed a mean underestimation of 4.0% (95% CI 3.3% to 4.6%) for the same age range. CONCLUSIONS: The LO formula has been validated in several studies and proven to be a superior age-based weight estimation formula in many western emergency departments. This study shows that the LO formula leads to less underestimation of weights in Irish children than the APLS formula. It is a simple, safe and more accurate age-based estimation formula that can be used over a large age range (1-15 years).

Sacral insufficiency fractures: an easily overlooked cause of back pain in the ED.

Sacral insufficiency fractures are an important and treatable cause of severe back pain. Despite publication of several case reports since its original description in 1982, awareness of these injuries remains inadequate in emergency medicine. Most patients are elderly women presenting with intractable lower back pain. Postmenopausal osteoporosis is the most significant risk factor. Marked sacral tenderness is common. Neurologic impairment is rarely detectable. Routine radiography of the spine and pelvis is usually inconclusive. Computed tomography remains the diagnostic modality of choice. Treatment is usually conservative.