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PEDIATRICS/SYSTEMATIC REVIEW/META-ANALYSIS
Weight Estimation Methods in Children:

A Systematic Review
Kelly D. Young, MD, MS*; Noah C. Korotzer
*Corresponding Author. E-mail: kyoung@emedharbor.edu.
Study objective: We seek to collect, review, evaluate, and synthesize the current literature focusing on all published
methods of pediatric weight estimation.
Methods: We conducted a literature review using PubMed and Web of Science databases, and the Google Scholar
search engine, with the similar articles feature, as well as review of the bibliographies of identied studies. We
excluded studies estimating weight of neonates, predominantly adults without separate information for children, child
self-reported weight, and studies estimating outcomes other than weight. Quantitative outcomes of accuracy (proportion
within 10% of actual weight), mean percentage error, and mean bias were preferred.
Results: Eighty studies met inclusion criteria with predominant methods: parent or health care worker weight
estimation, age-based formulae, and length-based estimation without (eg, Broselow) or with adjustment for body
habitus (eg, Pediatric Advanced Weight-Prediction in the Emergency Room, Mercy). Parent estimation was the most
accurate at predicting total (actual) body weight, with length-based methods with habitus adjustment next. Lengthbased methods outperformed age-based formulae, and both tended to underestimate the weight of children from
populations with high obesity rates and overestimate the weight of children from populations with high malnourishment
rates. Health care worker estimation was not accurate.
Conclusion: Parent estimation and length-based methods with adjustment for body habitus are the most accurate
methods to predict childrens total (actual) body weight. Age-based formulae and length-based methods without habitus
adjustment likely tend to predict ideal body weight. [Ann Emerg Med. 2016;68:441-451.]
Please see page 442 for the Editors Capsule Summary of this article.
A podcast for this article is available at www.annemergmed.com.
0196-0644/$-see front matter
Copyright 2016 by the American College of Emergency Physicians.
http://dx.doi.org/10.1016/j.annemergmed.2016.02.043
INTRODUCTION
Because there is often insufcient time to weigh critically
ill children, rapid, reliable weight estimation is an essential
step in pediatric emergency resuscitation. Dosing of
resuscitation drugs in children is weight based. Methods to
select properly sized resuscitation equipment are often
weight based also. The ideal weight estimation method
should be accurate and reliable, quick to obtain, easy to use,
and readily available. It should also be available for out-ofhospital use so that a patients estimated weight can be
communicated to the emergency department (ED) team
before the patients arrival, allowing advance preparation of
equipment and medications.
Several weight estimation methods have been
published in the literature. A simple method studied is
weight estimation by parents and health care workers
such as nurses, physicians, and paramedics. One of the
oldest methods is the use of formulae calculated according
Volume 68, no. 4 : October 2016
to the childs age, such as the Advanced Pediatric Life

Support, Luscombe-Owens, and Nelson formulae.1-3
These formulae are often recommended in pediatric
textbooks and as part of national pediatric resuscitation
courses.
Length-based methods have included the use of weight
for length data from large data sets such as the National
Health and Nutrition Examination Survey (NHANES) or
those from the World Health Organization (WHO), and
formulae derived through regression. The Broselow tape,
based on NHANES data, is the most widely used lengthbased method.4,5 The tape is placed next to a supine child
between 46 and 143 cm tall, with the top of the tape at
the top of the childs head. The estimated weight is read
according to where the childs heels fall on the tape. A
small range of weights is grouped into a color zone, and
resuscitation medication dosing and equipment sizing is
listed on the tape for each color zone.
Annals of Emergency Medicine 441
Weight Estimation Methods in Children
Editors Capsule Summary
What is already known on this topic

Medication dosages for children are mostly based on
weight. In many critical situations, childrens weight
is unknown.
What question this study addressed
This literature review made an inventory of all
published methods of pediatric weight estimation
and compared their relative accuracy.
What this study adds to our knowledge
Among multiple strategies suggested, parental
estimation is the most accurate, being within 10% of
the real body weight in 70% to 80% of cases. In the
absence of a parent, length-based strategies adjusted
for body habitus are the preferable choice.
How this is relevant to clinical practice
This study demonstrated the limitations of childrens
weight estimation and the importance of using a
length-based strategy adjusted for body habitus in the
absence of a parental authority.
Because concern has increased in regard to underestimation

of actual weight with length-based methods because of
increasing child obesity, methods using length plus
adjustments for body habitus, or other anthropometric
measurements such as mid upper-arm circumference, have
been proposed.6 The Paediatric Advanced WeightPrediction in the Emergency Room (PAWPER) tape reports
WHO weight-for-length data at the fth (very thin), 25th
(thin), 50th (average), 75th (heavy), and 95th (obese)
percentiles and covers lengths (heights) from 46 to 150 cm.7
The Mercy method combines a length-based predictor,
humeral length, with a habitus adjustment predictor, mid
upper-arm circumference, with each contributing fractional
estimated weights.8
To our knowledge, there has not yet been a full systematic
review of all the published methods for weight estimation in
children, nor of the numerous studies comparing their
relative accuracy. We sought to collect, review, evaluate, and
synthesize the current literature focusing on all published
methods of pediatric weight estimation.
MATERIALS AND METHODS
A literature search was conducted with the PubMed and
Web of Science databases, using the terms Broselow and
(weight AND estimation) AND (pediatric OR child OR
children). Additional sources were identied with the search
442 Annals of Emergency Medicine
Young & Korotzer
engine Google Scholar, and the PubMed and Google Scholar

search feature similar articles, as well as through review of
bibliographies of included studies. Study abstracts were
screened if they covered the subject of estimating weight in
children outside the neonatal (newly born) age group.
Studies that were either peer-reviewed literature or original
research published in a medical journal were included,
whereas studies presented only in abstract form, in letters to
the editor, or in newsletters were not. Studies were excluded if
they aimed to estimate the weight solely of neonates, if they
studied child self-reported weight, if they included
predominantly adults without separate data for children
reported, or if they contained insufcient data to assess a
quantitative outcome. Studies were also excluded if they
studied accuracy of drug dosing and not weight estimation,
or if they studied estimation of lean body mass rather than
weight. Studies of the Broselow tape that reported accuracy
of color zones but not exact weight were included. The
literature search and identication and screening of studies
were performed by both authors together, with the rst
author mentoring the second, who is a high school student.
Studies included were reviewed and categorized by both
authors. Data were gathered on the methods of estimation
used, the number and ages of pediatric patients studied, the
geographic and institutional location where the study was
conducted, whether the estimations were made prospectively
by measuring patients (measured) or retrospectively
according to chart review of recorded height or length
(virtual) or age, and reported outcomes measuring the
accuracy of the methods.
The most common quantitative outcomes reported
were percentage of patients with estimated weight within
10% or 20% of actual weight, mean percentage error of
estimated weight from actual weight (eg, if mean actual
weight were 10 kg but mean estimated weight were 12 kg,
there would be a mean percentage error of 1210 kg2
kg/10 kg20%), mean bias in kilogram over- or
underestimation of mean estimated weight from mean
actual weight, and correlation coefcient between
estimated and actual weights. We showed preference for
and reported outcomes in this order: percentage within
10% of actual weight (referred to simply as accuracy),
then mean percentage error, then mean bias, and then
correlation coefcient (r). Some studies calculated mean
percentage error and mean bias by subtracting actual
weight from estimated weight, whereas others reversed that
calculation. We transformed the mean percentage error
and mean bias results to always reect estimated weight
minus actual weight such that negative mean percentage
error or mean bias meant the weight estimation method
underestimated actual weight.
Young & Korotzer
RESULTS
We screened the abstracts of 131 studies and excluded 16
after screening and an additional 35 after full-text review
(Figure). We thus included 80 studies on the topic of
estimating weight in pediatric patients that met our inclusion
criteria in this review.2,4,6-83 Studies were published from
1986 to 2016 and were conducted in 23 countries, although
more were from the United States. Studies were
predominantly performed in ED and clinic populations,
although some used other sources such as schools, day care
establishments, inpatient wards, and national survey data.
The main methods studied included visual estimation;
age-based formulae; length-based methods, eg, the Broselow
tape; and habitus-adjusted methods (Table 1).
Included
Eligibility
Screening
Idencaon
Records idened through

database searching
(n = 2484)
Several studies investigated patient and provider abilities

to accurately guess childrens weight (Table E1, available
online at http://www.annemergmed.com). Parents and
legal guardians were highly accurate, generally with 70% to
80% within 10% of actual weight, whereas estimations
by physicians, nurses, and paramedics were less accurate.
There were many studies assessing the utility of formulae
based on age (most common), length or height, or mid
upper-arm circumference (Table E2, available online at
http://www.annemergmed.com). Studied formulae are
listed in Table 2. Age-based formulae applied to children
from developed countries with high rates of overweight or
obese patients generally tended to underestimate actual
weight, with worsening performance in older or heavier
Addional records idened

through other sources
(n = 74)
Records screened without regard to

presence of duplicates
(n = 2558)
Records screened
(n = 2558)
Full-text arcles assessed

for eligibility
(n = 115)
Records excluded
(n = 2443)
2427 not on topic of child
weight esmaon
7 adult paents only
5 child self reported
weight / body image
study
4 esmated weight
through predictors
not easily available
Full-text arcles excluded,

with reasons
(n = 35)
14 abstracts
7 adult paents only
2 predominantly adults
5 outcome of interest not
reported
4 leers to editor
1 newsleer arcle
1 overlapping data with
previously published
arcle
1 report of a proposed
method but not a study
Studies included in
qualitave synthesis
(n = 80)
Figure. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) ow diagram.
Young & Korotzer
Table E5
Individual methods not extensively studied
Miscellaneous
EMS, Emergency medical services; DWEM, Devised Weight Estimate Method.

*Electronic tables are available online at http://www.annemergmed.com.
DWEM, Mercy, PAWPER
Method uses published growth data (eg, NHANES,

WHO) to return estimated weight with
adjustment for body habitus through either
<50th percentile for thin and >50th percentile
for overweight, or uses mid-arm circumference
A variety of other methods have been proposed but
not extensively studied
Habitus adjusted
Broselow
Method uses published growth data (eg, NHANES,
WHO) to return 50th percentile weight for
measure length/height
Formulae
Length based
Foot length, facial measurements,

growth charts
Table E4
Table E3
Table E2
Table E1
Parents/legal guardians highly accurate, others

insufcient accuracy.
Age-based formulae tend to underestimate weight in
obese and overestimate in malnourished. They are
thus thought to better predict ideal body weight
than total (actual) body weight. Age based perform
less well than length/height based.
Performs better than age-based formulae, although
also underestimates in obese and overestimates in
malnourished. Also thought to better predict ideal
body weight than total (actual) body weight.
Habitus-adjusted methods perform better at
estimating total body weight (patients actual
weight), rather than ideal body weight. Mercy most
accurate in predicting total body weight.
Parents/legal guardians, physicians,
nurses, EMS personnel
See Table 2
After visualizing the patient, a guess about the
patients weight is made
Mathematical formulae based most often on
patients age in years or months, sometimes
based on patient length/height or midarm
circumference
Estimation
Description
Method
Table 1. Primary methods of weight estimation studied.
Examples
Summary of Findings
Web Appendix
Detailed Table*
children. When applied to children from geographic areas

in which underweight or malnutrition are common, agebased formulae tended to overestimate actual weight.
Length- or height-based formulae were more accurate but
required complex calculations. When directly compared,
methods based on anthropometric measurements such as
the Broselow or Mercy tapes outperformed age-based
formulae. A formula based on mid upper-arm
circumference did not show performance superior to
that of age-based formulae.73,78,79
The most common nonformula method for predicting
actual weight was length based, of which the most common
and most widely accepted method is the Broselow tape.
Forty-six studies of the Broselow method performed in a
wide variety of countries were identied (Table E3,
available online at http://www.annemergmed.com). The
average accuracy (proportion of estimated weights within
10% of actual weight) for the Broselow method was
54%, and Broselow was generally superior when directly
compared with age-based formulae or health care worker
estimation. Similar to age-based formulae, the Broselow
method tended to underestimate actual weight in children
from developed countries and overestimate it in children
from countries in which underweight or malnutrition are
common. Some investigators noted that applying an 8%
to 10% correction factor improved accuracy of the
Broselow method in populations in which it systematically
overestimated actual weight.33,77 Where reported, the
majority of patients were within 1 color zone of the correct
Broselow color zone.29,72,77
Fifteen studies investigated methods incorporating
adjustment for body habitus (Table E4, available online
at http://www.annemergmed.com). An early method
published at approximately the same time as the rst
Broselow study is the Devised Weight Estimate Method,
a table of estimated weights for length or height of 50 to
175 cm for 3 different habitus: slim, average, and heavy.9
Although the Devised Weight Estimate Method
performed as well as or sometimes better than Broselow,
it did not become as popular and has not been studied
frequently. The newer PAWPER tape, which reports
WHO weight-for-length data at the fth (very thin), 25th
(thin), 50th (average), 75th (heavy), and 95th (obese)
percentiles, has been shown to be slightly superior to
the Broselow tape in predicting actual weight.7,78 The
Mercy method, originally calculated from a table by
adding the fractional weights predicted by mid upperarm circumference and humeral length, and later
developed into 2- and 3-dimensional tapes used to obtain
these 2 anthropometric measurements and report the
corresponding estimated weight, showed improved
ARC
Argall
Best Guess
ERC or EPLS
Australian Resuscitation
Council,85 1996
Argall et al,21 2003
Tinning and Acworth,30 2007
Lefer
European Resuscitation
Council,86 2006
Lefer and Hayes,13 1997
Luscombe-Owens
Luscombe and Owens,2 2007
Nelson
Berhman et al,3 2004
Shann
Hazell,87 2000
Theron
Theron et al,22 2005
Traub-Johnson
Traub and Johnson,88 1980
Traub-Kichen
Traub and Kichen,89 1983
Garwood-McEwen
Michigan
Park
Garwood and McEwen,91 2012

Ackwerh et al,65 2014
Park et al,51 2012
Tintinalli
Tintinalli et al,92 2000
110 y
111 mo
15 y
612 y
19 y
10 y
110 y
<12 mo
14 y
514 y
110 y
2(age in years4)
(0.5age in months)4
2(age in years4)
(3age in years) 7
2(age in years4)
3.3 (age in years)
3(age in years2)
(age in months9)/2
2(age in years5)
4 (age in years)
2(age in years4)
<12 mo
15 y
110 y
2 (age in years)10
(age in months)/24
3 (age in years)7
312 mo
16 y
712 y
19 y
>9 y
010 y
(age in months9)/2
(2age in years)8
[7(age in years)5]/2
2 (age in years)9
3 (age in years)
e [2.200.175(age in years)]
118 y
Boys >60 in
Girls >60 in
117 y, and
length/height
>74 cm
Origin
Comments
USA
USA
Underestimates weight in average or obese

children. Performs better in developing
countries/thin children, younger children.
Australia

children
Performs better in younger children
Overestimates weight in thin or average children.
Performs better in younger children.
UK
Australia
Europe
Same formula as APLS 2001
USA
Overestimates in young children, underestimates

in older children
children
Performs better in younger children
UK
USA
New Zealand
Performs better than other formulae for larger

children
New Zealand Pacic Complex calculations. Performs better in older
Islander and Maori
children.
2.05e [0.02(height in centimeters)] USA
Length-based, performs better than age-based
392.27[(height in inches)60]
formulae. Complex calculations.
42.22.27[(height in inches)60]
2.3961.0188 (height in centimeters) USA
Length based; performs better than age-based
formulae. Complex calculations.
15 y
111 y
2.5 (age in years)8

(midarm circumference in cm10)3
Trinidad and Tobago

China
110 y
3 (age in years)5
China
This formula studied only in this study

Formula based on mid upper-arm circumference in
cm
16 y
710 y
19 y
[(7age in years)25]/3
4 (age in years)4
2.5 (age in years)7.5
China
USA
016 y
212 y
012 mo
14 y
514 y
112 y
(age in months/4)6
3 (age in years)10
(age in months9)/2
2 (age in years)9
4 (age in years)1
(2age in years)10
UK
USA
Korea
Mnemonic: 5 ngers of hand1, 3, 5, 7, 9 y,

associated with 10, 15, 20, 25, 30 kg
This formula not widely studied
USA
Similar to Lefer
APLS, Advanced Pediatric Life Support; ARC, Australian Resuscitation Council; ERC, European Resuscitation Council; EPLS, European Paediatric Life Support; CAWR, Chinese Age Weight Rule; CAWR2, Chinese Age Weight
Rule2 Part.
Other formulae less commonly studied

Ali
Ali et al,49 2012
Cattermole
Cattermole
et al,39 2010
CAWR
Cattermole
et al,41 2011
CAWR2
Cattermole
et al,41 2011
Finger-counting (Handtevy) Antevy,90 2013
Formula for Weight in Kilograms
Commonly studied formulae

APLS 2001
Mackway-Jones et al,84 2001
APLS 2011
Samuels et al,1 2011
Age Range
Reference
Formula Name
Young & Korotzer
Table 2. Formulae based on age, length or height, or midarm circumference.
accuracy of 70% to 77%.8,56,59 Studies of the Mercy

method were performed in a variety of populations,
including in the United States, Mali, and India, and in
Down syndrome patients, and accuracy was similar across
populations.63,79,80
Additional studies investigated a potpourri of other
methods such as anthropometric measurements other
than length or height (foot length, mid upper-arm
circumference, and humeral length), growth charts,
hanging leg weight (weight of both legs raised at a
45-degree angle in a sling), age taken from clothing
labels, facial measurements (proposed to be performed
with facial recognition software), and nger-counting
mnemonics (Table E5, available online at http://www.
annemergmed.com).
LIMITATIONS
Although we attempted to be as complete as possible in
identifying eligible studies, we were unable to search the
EMBASE database and did not perform a search of gray
literature, eg, conference proceedings, technical or annual
reports, or government documents. Participation of a
high school student is also a potential limitation, although
he was closely mentored by the rst author. Studies
reviewed were heterogeneous and of variable quality,
including patients from a wide variety of periods,
geographic locations, treatment areas, and age groups.
Methodology also varied widely, including differences in
outcomes studied, recording of criterion standard weight
as with or without clothing, actual use of the Broselow
tape as intended versus applying the childs measured
length or height from chart review to a Broselow tape,
and version of Broselow tape used. This heterogeneity
limited the ability to perform a true meta-analysis. Several
studies were found in abstract form only and could not be
included in this review, indicating a signicant
publication bias in this area of study.
DISCUSSION
We reviewed all available literature on methods to
estimate weight in pediatric patients. The most common
methods were formulae based on age, and length-based
estimates, in particular, the Broselow tape. Length-based
methods perform better than age-based formulae or health
care worker estimation. Recent methods have improved
accuracy by making adjustments to length-based estimates
for body habitus or by using anthropometric measurements
that vary according to body habitus such as mid upper-arm
circumference.
Visual estimation by parents, paramedics, nurses, or
physicians is the simplest method, requiring no equipment.
Young & Korotzer
Unfortunately, with the exception of that conducted by

parents, visual estimation is not accurate. Parent-reported
weights are highly accurate, but parents may not be present
for a resuscitation, or at least not for the initial portion, or
they may be distraught.
Age-based formulae have a major advantage in that
they do not require special equipment to estimate weight
and thus can be used by any health provider, although
knowledge of the patients age is required. One study
applied common age-based formulae to the ages from
childrens clothing labels to troubleshoot the potential
problem of unknown age.52 Different formulae have
shown better results in different populations; for
example, Advanced Pediatric Life Support and Argall
formulae perform better in underweight populations
(such as in developing nations), whereas the Nelsons,
Luscombe-Owens, and Best Guess formulae perform
better in populations with a higher percentage of
overweight and obese children.93 Typically, age-based
formulae can provide estimations only for children up
to aged 12 years and do not tend to perform as well in
older children.
A signicant disadvantage to use of formulae is that
they require practitioners to remember the formula, which
can create error and which may be difcult to perform in
a high-stress pediatric resuscitation situation.94 They also
require mental math, adding to the potential for error and
stress in the scenario of pediatric resuscitation. Simpler
formulae with a single easily calculated formula for all
age groups are easier to remember and calculate, but less
accurate than more complex multipart formulae. To assist
in memory, some investigators have proposed mnemonic
devices, such as nger-counting methods.90,95
Length-based methods, most prevalently the Broselow
tape, have long been used and are generally more accurate
than age-based formulae. However, because growth curves
change over time, length-based methods may require
updating. The Broselow tape was rst created in 1998,
using 1979 National Center for Health Statistics data.
Since then, the tape has been updated several times with
newer NHANES data to accommodate for changing
growth curves.96 Methods that produce regression formulae
based on length, such as the Traub-Kichen and TraubJohnson formulae, have not been similarly updated. The
Broselow tape performs best in smaller children, generally
those who weigh less than 25 kg. Potential limitations
of the Broselow tape are its cost, the range covered,
generalizability, and that it requires a measuring device to
which many practitioners may not have easy access. The
cost of the Broselow tape is approximately $25. Also,
Broselow tape use is limited by tape length to children
Young & Korotzer
between 46 and 143 cm tall. Finally, the Broselow tape is

based on data from US children and may not perform as
well in other populations. Advantages to the Broselow tape
as a system are that it includes drug dosages and equipment
sizes printed on the tape for easy reference, and it has
been coordinated with cart systems with colored drawers to
stock equipment sizes appropriate for each color zone.
Investigators have attempted to improve the accuracy
of length-based weight estimation by adding adjustments
based on body habitus, particularly as concerns increase
in regard to the accuracy of the Broselow tape in the
face of increasing child obesity rates. Additionally,
because the tape is based on NHANES data from US
children, investigators from developing nations have
raised concerns that Broselow weights overestimate the
weights of children in their populations. The rst
proposed hybrid method, the Devised Weight Estimate
Method, although developed at the same time as the
Broselow tape, did not gain widespread use.9 It is limited
to children of length or height 50 to 175 cm, requires
practitioner access to a table, and has not been updated
with new growth curve data. The more recent PAWPER
method, on the other hand, has been shown to be
more accurate than methods based on length alone.7
Disadvantages include that it requires special equipment
(the tape) and is limited to use in children of length or
height 46 to 150 cm. Unlike the Broselow tape, the
PAWPER tape does not use color zones and does not
have drug doses or equipment sizes on the tape. Another
method of habitus adjustment suggested by investigators
in India and by Broselow himself is to adjust the
Broselow-predicted weight up or down, depending on
patient habitus. Investigators in India have proposed
reducing Broselow-predicted weight by 8% to 10% to
improve weight estimation accuracy in an underweight
population.33,77 Broselow suggested moving up a color
zone when a child appears obese and the drug to be dosed
warrants adjustment.96
Other investigators have used anthropometric
measurements other than length or height. Although they
are beyond the scope of this review, several studies of
neonates correlating anthropometric measurements
with estimated weight have shown mid upper-arm
circumference and chest circumference to be good
predictors in addition to length.97,98 The Mercy method
uses 2 anthropometric measurements: humeral length
functions similarly to overall length and mid upper-arm
circumference adjusts as for body habitus adjustment.8
This method has been validated in children aged 2
months to 16 years and has performed well in various
geographic regions and patient populations, and across
different body habitus.56,59,63,79,80 A disadvantage is that

it requires the practitioner to carry a table of fractional
weights for each of the 2 measurements, or a Mercy tape.
The Mercy tape has been Food and Drug Administration
approved and is likely to be sold commercially soon.
Studies to date have shown it to be superior to other
methods in estimating total (actual) body weight, but it
has not been widely externally validated.
Although some investigators have striven to nd
methods that better predict total (actual) body weight in
an increasingly obese pediatric population, others noted
that the majority of resuscitation drugs are better dosed
according to ideal body weight. Carasco et al99 posited that
hydrophobic (lipophilic) drugs are distributed preferentially
to fat mass and are better dosed according to total body
weight, whereas the volume of distribution of hydrophilic
drugs is more related to lean body mass and therefore
better dosed according to ideal body weight. Of common
emergency drugs, amiodarone, atropine, lidocaine,
etomidate, ketamine, propofol, fentanyl, steroids, and
anticonvulsants such as benzodiazepines and phenytoin are
hydrophobic, whereas adenosine, epinephrine, calcium,
magnesium, and sodium bicarbonate are hydrophilic.99-101
In a study of inpatient cardiac arrests, overweight children
had higher mortality compared with normal-weight or
underweight children; drug dosing may have been one
contributing factor to this nding.102
Luten and Zaritsky103 pointed out that even
hydrophobic drugs require time to be distributed to the fat
mass, and a large initial bolus dose based on total body
weight could cause toxic levels to be reached in the central
compartment before redistribution. They therefore posited
that most drugs should be dosed according to ideal body
weight regardless of whether they are hydrophobic or
hydrophilic. The one exception is succinylcholine, which,
although hydrophilic, because of an increased activity level
of pseudo-cholinesterase in obese patients should be dosed
according to total body weight.101,103 For underweight
children, however, use of ideal body weight may result in
overdose if total body weight is less than ideal body weight,
a particular concern when dosing, for example, sedatives or
narcotics. Also, when resuscitation equipment sizing is
based on weight, ideal body weight should be used because
obese children are likely to require the same size of, for
example, endotracheal and thoracostomy tubes and vascular
catheters as lean children of similar age.
Some experts suggest that for morbidly obese patients in
whom there is a slight increase in lean body mass because of
increased vasculature, the formula ideal body weightX
(total body weightideal body weight) where X0.250.4
can be used to determine a dosing weight, or adjusted
Young & Korotzer
body weight.100,103,104 The value of the cofactor X is based

theoretically on an estimate of a 25% to 40% increase in
lean body mass in morbidly obese patients, or a 30% water
content in adipose tissue, and has not been formally studied.
Several other factors besides the hydrophilicity of a drug
may affect drug dosing in obese patients, such as changes
in the extracellular uid space, drug clearance, and blood
volume and cardiac output.105 The medications indication
for use may also play a role; for example, underdosing a
benzodiazepine used to treat active seizures would be
problematic, but underdosing the same benzodiazepine and
titrating up as needed for procedural sedation would be
appropriate. There is a paucity of pharmacokinetic data
Table 3. Recommended dosing weight for common pediatric
emergency drugs.*
Drug Characteristic
Hydrophilic
Adenosine
Calcium (all forms)
Ceftriaxone
Epinephrine
Esmolol
Labetalol
Levetiracetam
Magnesium sulfate
Mannitol
Morphine
Propranolol
Rocuronium
Sodium bicarbonate
Succinylcholine
Vecuronium
Hydrophobic (lipophilic)
Amiodarone
Atropine
Dexamethasone
Diazepam
Etomidate
Fentanyl
Hydrocortisone
Hydromorphone
Ketamine
Lidocaine
Lorazepam
Midazolam
Phenytoin
Propofol
Thiopental
Verapamil
Recommended weight to use for dosing

(Ross et al104)
No recommendation
IBW
TBW with adult max
IBW
No recommendation
No recommendation
AdjBW, cofactor 0.25
IBW
IBW
IBW
No recommendation
IBW
AdjBW, cofactor of 0.8
IBW
TBW
TBW
TBW with adult max
IBW; consider loading on TBW
No recommendation
TBW
IBW, titrate to effect
TBW loading dose, IBW maint
TBW loading dose, IBW maint
IBW, titrate to effect
TBW with adult max load, AdjBW maint
dose, cofactor 0.3
TBW
No recommendation
No recommendation
IBW, Ideal body weight (used as a proxy for lean body mass); TBW, total body weight
(essentially, actual body weight); AdjBW, adjusted body weight, using the formula
IBW(TBWIBW)cofactor.
*Recommendations are from the study by Ross et al104 of recommendations from a
group of clinical pharmacists at Childrens Hospital of Colorado. Carrasco et al99
recommended using IBW for all hydrophilic drugs and TBW for hydrophobic drugs.
Luten and Zaritsky103 recommended using IBW (or AdjBW with cofactor 0.4 for
morbidly obese) in most cases of emergency drug dosing, with the exception of
succinylcholine, for which they recommend TBW.
for dosing emergency medications in obese children.105-107

Ross et al104 reported the recommendations of a task force
subcommittee of clinical pharmacists at Childrens Hospital
Colorado for drug dosing (Table 3). Recommendations
were made according to available literature, known
pharmacokinetic properties of drugs, the potential
consequences of under- or overdosing a particular
medication, and a preference for uniform dosing for a
particular class of drugs (eg, opiates).
The ideal weight estimation method is accurate across
different populations, quick, and easily accessible; does not
require special equipment; and does not rely on practitioner
memory or complex mental calculations. A comprehensive
review of the literature revealed that no reported method is
ideal. Practitioner estimation is not adequately accurate or
reliable, and parent estimation, although accurate, may be
unavailable at resuscitation. Simpler methods requiring no
equipment such as age-based formulae sacrice the accuracy
found in methods such as length-based tapes and the Mercy
method, whereas length-based tapes and the Mercy method
require special equipment and may be prohibitively costly to
some practitioners. Additionally, methods vary in ability to
predict total (actual) body weight versus ideal body weight,
and preferences for one or the other may exist when
individual drugs are dosed. Parent estimation and lengthbased methods with adjustment for body habitus (eg,
PAWPER, Mercy) are the most accurate methods to predict
childrens total (actual) body weight. Age-based formulae
and length-based methods without habitus adjustment (eg,
Broselow) likely tend to predict ideal body weight.
Supervising editors: Jocelyn Gravel, MD; Steven M. Green, MD
Author afliations: From the David Geffen School of Medicine at
UCLA, University of California, Los Angeles, and the Department of
Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA
(Young); and the Palos Verdes Peninsula High School, Rolling Hills
Estates, CA (Korotzer).
Funding and support: By Annals policy, all authors are required to
disclose any and all commercial, nancial, and other relationships
in any way related to the subject of this article as per ICMJE conict
of interest guidelines (see www.icmje.org). The authors have stated
that no such relationships exist.
Publication dates: Received for publication November 12, 2015.
Revisions received February 4, 2016, and February 9, 2016.
Accepted for publication February 19, 2016. Available online April
19, 2016.
REFERENCES
1. Samuels M, Wieteska S, eds. Advanced Paediatric Life Support: The
Practical Approach. West Sussex, UK: John Wiley & Sons, Ltd; 2011.
2. Luscombe M, Owens B. Weight estimation in resuscitation: is the
current formula still valid? Arch Dis Child. 2007;92:412-415.
Young & Korotzer

3. Behrman R, Kliegman R, Jenson H. Nelson Textbook of Pediatrics.
17th ed. Philadelphia, PA: Saunders; 2004.
4. Lubitz DS, Seidel JS, Chameides L, et al. A rapid method for
estimating weight and resuscitation drug dosages from length in the
pediatric age group. Ann Emerg Med. 1988;17:576-581.
5. Meguerdichian MJ, Clapper TC. The Broselow tape as an effective
medication dosing instrument: a review of the literature. J Pediatr
Nurs. 2012;27:416-420.
6. Milne WK, Yasin A, Knight J, et al. Ontario children have outgrown the
Broselow tape. CJEM. 2012;14:25-30.
7. Wells M, Coovadia A, Kramer E, et al. The PAWPER tape: a new
concept tape-based device that increases the accuracy of weight
estimation in children through the inclusion of a modier based on
body habitus. Resuscitation. 2013;84:227-232.
8. Abdel-Rahman S. An improved pediatric weight estimation strategy.
Open Med Dev J. 2012;4:87-97.
9. Garland JS, Kishaba RG, Nelson DB, et al. A rapid and accurate
method of estimating body weight. Am J Emerg Med. 1986;4:
390-393.
10. Hughes G, Spoudeas H, Kovar IZ, et al. Tape measure to aid prescription
in paediatric resuscitation. Arch Emerg Med. 1990;7:21-27.
11. Haftel AJ, Khan N, Lev R, et al. Hanging leg weighta rapid technique
for estimating total body weight in pediatric resuscitation. Ann Emerg
Med. 1990;19:523-526.
12. Greig A, Ryan J, Glucksman E. How good are doctors at estimating
childrens weight? J Accid Emerg Med. 1997;14:101-103.
13. Lefer S, Hayes M. Analysis of parental estimates of childrens
weights in the ED. Ann Emerg Med. 1997;30:167-170.
14. Goldman RD, Buskin S, Augarten A. Parental estimates of their
childs weight: accurate for resuscitation drug doses. Pediatr Emerg
Care. 1999;15:19-21.
15. Molyneux E, Brogan R, Mitchell G, et al. Childrens weights: guess or
measure by tape? Lancet. 1999;354:1616.
16. Harris M, Patterson J, Morse J. Doctors, nurses, and parents are
equally poor at estimating pediatric weights. Pediatr Emerg Care.
1999;15:17-18.
17. Kun W, Cheng K, Yuen M, et al. How good is the Broselow tape
measurement for estimation of body weights in paediatric patients
for application in Hong Kong? Hong Kong J Paediatr. 2000;5:
25-30.
18. Vilke GM, Marino A, Fisher R, et al. Estimation of pediatric patient
weight by EMT-PS. J Emerg Med. 2001;21:125-128.
19. Black K, Barnett P, Wolfe R, et al. Are methods used to estimate
weight in children accurate? Emerg Med. 2002;14:160-165.
20. Hofer CK, Ganter M, Tucci M, et al. How reliable is length-based
determination of body weight and tracheal tube size in the paediatric
age group? the Broselow tape reconsidered. Br J Anaesth.
2002;88:283-285.
21. Argall JA, Wright N, Mackway-Jones K, et al. A comparison of two
commonly used methods of weight estimation. Arch Dis Child.
2003;88:789-790.
22. Theron L, Adams A, Jansen K, et al. Emergency weight estimation in
Pacic Island and Maori children who are large-for-age. Emerg Med
Australas. 2005;17:238-243.
23. Bavdekar SB, Sathe S, Jani P. Prediction of weight of Indian children
aged up to two years based on foot-length: implications for
emergency areas. Indian Pediatr. 2006;43:125-130.
24. Nieman CT, Manacci CF, Super DM, et al. Use of the Broselow tape
may result in the underresuscitation of children. Acad Emerg Med.
2006;13:1011-1019.
25. Varghese A, Vasudevan VK, Lewin S, et al. Do the length-based
(Broselow) tape, APLS, Argall and Nelsons formulae accurately
estimate weight of Indian children? Indian Pediatr. 2006;43:
889-894.
26. DuBois D, Baldwin S, King WD. Accuracy of weight estimation
methods for children. Pediatr Emerg Care. 2007;23:227-230.

27. Krieser D, Nguyen K, Kerr D, et al. Parental weight estimation of their
childs weight is more accurate than other weight estimation methods
for determining childrens weight in an emergency department?
Emerg Med J. 2007;24:756-759.
28. Jang HY, Shin SD, Kwak YH. Can the Broselow tape be used to
estimate weight and endotracheal tube size in Korean children? Acad
Emerg Med. 2007;14:489-491.
29. Hashikawa A, Juhn Y, Homme J, et al. Does length-based resuscitation
tape accurately place pediatric patients into appropriate color-coded
zones? Pediatr Emerg Care. 2007;23:856-861.
30. Tinning K, Acworth J. Make your Best Guess: an updated method for
paediatric weight estimation in emergencies. Emerg Med Australas.
2007;19:528-534.
31. Thompson MT, Reading MJ, Acworth JP. Best Guess method for agebased weight estimation in paediatric emergencies: validation and
comparison with current methods. Emerg Med Australas. 2007;19:
535-542.
32. Kelly A-M, Kerr D, Clooney M, et al. External validation of the Best
Guess formulae for paediatric weight estimation. Emerg Med
Australas. 2007;19:543-546.
33. Ramarajan N, Krishnamoorthi R, Strehlow M, et al. Internationalizing
the Broselow tape: how reliable is weight estimation in Indian
children? Acad Emerg Med. 2008;15:431-436.
34. Sandell JM, Charman SC. Can age-based estimates of weight be safely
used when resuscitating children? Emerg Med J. 2009;26:43-47.
35. So T-Y, Farrington E, Absher RK. Evaluation of the accuracy of
different methods used to estimate weights in the pediatric
population. Pediatrics. 2009;123:e1045-e1051.
36. Yamamoto LG, Inaba AS, Young LL, et al. Improving length-based
weight estimates by adding a body habitus (obesity) icon. Am J Emerg
Med. 2009;27:810-815.
37. Partridge RL, Abramo TJ, Haggarty KA, et al. Analysis of parental and
nurse weight estimates of children in the pediatric emergency
department. Pediatr Emerg Care. 2009;25:816-818.
38. Casey J, Borland M. Best Guess method: a further external validation
study and comparison with other methods. Emerg Med Australas.
2010;22:68-74.
39. Cattermole GN, Leung PYM, Mak PSK, et al. Mid-arm circumference
can be used to estimate childrens weights. Resuscitation.
2010;81:1105-1110.
40. Kelly A-M, Nguyen K, Krieser D. Validation of the Luscombe weight
formula for estimating childrens weight. Emerg Med Australas.
2011;23:59-62.
41. Cattermole GN, Leung MPY, So H-K, et al. Age-based formulae to
estimate childrens weight in the emergency department. Emerg Med
J. 2011;28:390-396.
42. Knight JC, Nazim M, Riggs D, et al. Is the Broselow tape a reliable
indicator for use in all pediatric trauma patients? a look at a rural
trauma center. Pediatr Emerg Care. 2011;27:479-482.
43. Rosenberg M, Greenberger S, Rawal A, et al. Comparison of Broselow
tape measurements versus physician estimations of pediatric
weights. Am J Emerg Med. 2011;29:482-488.
44. Luscombe MD, Owens BD, Burke D. Weight estimation in paediatrics:
a comparison of the APLS formula and the formula weight3(age)
7. Emerg Med J. 2011;28:590-593.
45. Geduld H, Hodkinson PW, Wallis LA. Validation of weight estimation
by age and length based methods in the Western Cape, South Africa
population. Emerg Med J. 2011;28:856-860.
46. Bourdeau S, Copeland J, Milne WK. Accuracy of the Broselow tape in
estimating the weight of First Nations children. Can J Rural Med.
2011;16:121-125.
47. Seddon C, Lockitt L, Dhanjal S, et al. Validation of advanced
paediatric life support formulas for weight calculation in a multiethnic
population. ISRN Pediatr. 2012;2012:869634.
48. Sinha M, Lezine MW, Frechette A, et al. Weighing the pediatric
patient during trauma resuscitation and its concordance with
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
estimated weight using Broselow Luten Emergency Tape. Pediatr

Emerg Care. 2012;28:544-547.
Ali K, Sammy I, Nunes P. Is the APLS formula used to calculate
weight-for-age applicable to a Trinidadian population? BMC Emerg
Med. 2012;12:9.
Trakulsrichai S, Boonsri C, Chatchaipun P, et al. Accuracy of three
methods used for Thai childrens body weight estimation. J Med
Assoc Thai. 2012;95:1194-1199.
Park J, Kwak YH, Kim DK, et al. A new age-based formula for estimating
weight of Korean children. Resuscitation. 2012;83:1129-1134.
Elgie LD, Williams AR. Using age on clothes size label to estimate
weight in emergency paediatric patients. Eur J Emerg Med.
2012;19:338-340.
Heyming T, Bosson N, Kurobe A, et al. Accuracy of paramedic
Broselow tape use in the prehospital setting. Prehosp Emerg Care.
2012;16:374-380.
Hegazy M, Taher E. Validating a new formula for weight estimation in
pediatric cancer patients. Int Res J Med Med Sci. 2013;1:34-39.
House DR, Ngetich E, Vreeman RC, et al. Estimating the weight of
children in Kenya: do the Broselow tape and age-based formulas
measure up? Ann Emerg Med. 2013;61:1-8.
Abdel-Rahman SM, Ahlers N, Holmes A, et al. Validation of an
improved pediatric weight estimation strategy. J Pediatr Pharmacol
Ther. 2013;18:112-121.
Loo PY, Chong S-L, Lek N, et al. Evaluation of three paediatric weight
estimation methods in Singapore. J Paediatr Child Health. 2013;49:
E311-E316.
Lim CAE, Kaufman BJ, OConnor J, et al. Accuracy of weight estimates
in pediatric patients by prehospital emergency medical services
personnel. Am J Emerg Med. 2013;31:1108-1112.
Abdel-Rahman SM, Paul IM, James LP, et al; Best Pharmaceuticals
for Children ActPediatric Trials Network. Evaluation of the Mercy
tape: performance against the standard for pediatric weight
estimation. Ann Emerg Med. 2013;62:332-339.e6.
Cattermole GN, Leung PYM, Graham CA, et al. Too tall for the tape:
the weight of schoolchildren who do not t the Broselow tape. Emerg
Med J. 2014;31:541-544.
Graves L, Chayen G, Peat J, et al. A comparison of actual to estimated
weights in Australian children attending a tertiary childrens hospital,
using the original and updated APLS, Luscombe and Owens, Best Guess
formulae and the Broselow tape. Resuscitation. 2014;85:392-396.
Young TP, Chen BG, Kim TY, et al. Finger counting: an alternative
method for estimating pediatric weights. Am J Emerg Med.
2014;32:243-247.
Dicko A, Alhousseini ML, Sidib B, et al. Evaluation of the Mercy
weight estimation method in Ouelessebougou, Mali. BMC Public
Health. 2014;14:270.
Erker CG, Santamaria M, Moellmann M. Size does matteragerelated weight estimation in tall n thin and tiny n thick children
and a new habitus-adapted alternative to the EPLS-formula.
Resuscitation. 2014;85:1174-1178.
Ackwerh R, Lehrian L, Nau OO. Assessing the accuracy of common
pediatric age-based weight estimation formulae. Anesth Analg.
2014;118:1027-1033.
Flannigan C, Bourke TW, Sproule A, et al. Are APLS formulae for
estimating weight appropriate for use in children admitted to PICU?
Resuscitation. 2014;85:927-931.
Allison N, Norton I. Emergency weight estimation in Aboriginal and
Torres Strait Islander children in the Northern Territory: are the
current methods accurate? Emerg Med Australas. 2014;26:487-493.
Chiengkriwate P, Donnapee R, Geater A. The accuracy of the
Broselow tape in the weight estimation of Thai children. Asian
Biomed. 2014;8:799-807.
Eke C, Ubesie A, Ibe B. Comparison of actual (measured) weights and
heights with the standard formula methods of estimation among
children in Enugu. Niger J Paediatr. 2014;41:307-311.
Young & Korotzer

70. Omisanjo AO, Orimadegun AE, Akinbami FO. Accuracy of Nelson and
Best Guess formulae in estimation of weights in Nigerian children
population. Ann Ib Postgrad Med. 2014;12:80-88.
71. Skrobo D, Kelleher G. CORKSCREW 2013 CORK study of childrens
realistic estimation of weight. Emerg Med J. 2015;32:32-35.
72. Khouli M, Ortiz MI, Romo-Hernndez G, et al. Use of the Broselow
tape in a Mexican emergency department. J Emerg Med.
2015;48:660-666.
73. Badeli H, Hashemian H, Nazari N, et al. The percentage of error of
different weight estimation methods toward actual weight in
children admitted to 17 Shahrivar Hospital. Int J Prev Med.
2015;6:13.
74. Young TP, Washington O, Flanery A, et al. Comparison of the nger
counting method, the Broselow tape and common weight estimation
formulae in Filipino children after Typhoon Haiyan. Emerg Med
Australas. 2015;27:239-244.
75. Britnell S, Koziol-McLain J. Weight estimation in paediatric
resuscitation: a hefty issue in New Zealand. Emerg Med Australas.
2015;27:251-256.
76. Garcia CM, Meltzer JA, Chan KN, et al. A validation study of the
PAWPER (Pediatric Advanced Weight Prediction in the Emergency
Room) tapea new weight estimation tool. J Pediatr. 2015;167:
173-177.e1.
77. Asskaryar F, Shankar R. An Indian pediatric emergency weight
estimation tool: prospective adjustment of the Broselow tape. Int J
Emerg Med. 2015;8:78.
78. Chavez H, Peterson RE, Lo K, et al. Weight estimation in an inner-city
pediatric ED: the effect of obesity. Am J Emerg Med. 2015;33:
1364-1367.
79. Talib NJ, Rahm G, Abdel-Rahman SM. Estimating weight in children
with Down syndrome. Glob Pediatr Health. 2015;2.
80. Batmanabane G, Jena PK, Dikshit R, et al. Using the Mercy method
for weight estimation in Indian children. Glob Pediatr Health.
2015;2.
81. Udoh II, Moses IJ. A comparison of three age-based formulae of
estimating weight in Nigerian children. Am J Med Sci Med.
2015;3:24-27.
82. Huang Z, Barrett JS, Barrett K, et al. Novel method to predict body
weight in children based on age and morphological facial features.
J Clin Pharmacol. 2015;55:447-451.
83. Clark MC, Lewis RJ, Fleischman RJ, et al. Accuracy of the Broselow
tape in South Sudan, the hungriest place on earth.. Acad Emerg
Med. 2016;23:21-28.
84. Mackway-Jones K, Molyneux E, Phillips B, et al. Advanced Pediatric
Life Support. 3rd ed. London, England: BMJ Publishing Group; 2001.
85. Advanced Life Support Committee of the Australian Resuscitation
Council. Paediatric advanced life supportthe Australian
Resuscitation Council guidelines. Med J Aust. 1996;165:199-206.
86. European Resuscitation Council. European Paediatric Life Support
(EPLS) Manual. London, England: Resuscitation Council; 2006.
87. Hazell W. Emergency Medicine at Your Fingertips. Auckland, New
Zealand: MediMedia; 2000.
88. Traub S, Johnson C. Comparison of methods of estimating creatinine
clearance in children. Am J Hosp Pharm. 1980;37:195-201.
89. Traub S, Kichen L. Estimating ideal body mass in children. Am J Hosp
Pharm. 1983;40:107-110.
90. Antevy P. First-hand approach. A novel method to rapidly calculate
pediatric drug dosages. JEMS. 2013;38:32-35.
91. Garwood J, McEwen A. Estimating pediatric weight: a new formula
[abstract]. Eur J Anaesth. 2012;29:153-154.
92. Tintinalli J, Kelen G, Stapcyznski J. Emergency Medicine: A
Comprehensive Study Guide. International Edition. 5th ed. New York,
NY: McGraw Hill; 2000.
93. Abdel-Rahman SM, Ridge A, Kearns GL. Estimation of body weight in
children in the absence of scales: a necessary measurement to
insure accurate drug dosing. Arch Dis Child. 2014;99:570-574.
Young & Korotzer

94. Marikar D, Varshneya K, Wahid A, et al. Just too many things to
remember? a survey of paediatric trainees recall of Advanced
Paediatric Life Support (APLS) weight estimation formulae. Arch Dis
Child. 2013;98; 921.
95. Marikar D. A novel tool to aid usability of age-based weight estimation
formulae. BMJ Innov. 2015;1:96-98.
96. Shaw G. Breaking news: a weighty matter for pediatric medication
dosing. Emerg Med News. 2014;36:1.
97. Goto E. Meta-analysis to estimate the correlation coefcients between
birthweight and other anthropometric measurements at birth. Indian
J Pediatr. 2011;78:311-318.
98. Goto E. Evaluation of anthropometric measurements at birth in
predicting birthweight less than 2000g in African and Asian
newborns: a meta-analysis. Rev Dpidmiologie Sant Publique.
2015;63:43-49.
99. Carasco CF, Fletcher P, Maconochie I. Review of commonly used age
based weight estimates for paediatric drug dosing in relation to the
pharmacokinetic properties of resuscitation drugs. Br J Clin
Pharmacol. 2012;97:A147-A149.
100. Brunette DD. Resuscitation of the morbidly obese patient. Am J
Emerg Med. 2004;22:40-47.

101. Walls RM, Murphy MF, eds. Manual of Emergency Airway
Management. 4th ed. Philadelphia, PA: Wolters Kluwer/Lippincott
Williams & Wilkins; 2012.
102. Srinivasan V, Nadkarni VM, Helfaer MA, et al; for the American
Heart Association National Registry of Cardiopulmonary
Resuscitation Investigators. Childhood obesity and survival after inhospital pediatric cardiopulmonary resuscitation. Pediatrics.
2010;125:e481-e488.
103. Luten R, Zaritsky A. The sophistication of simplicity.optimizing
emergency dosing. Acad Emerg Med. 2008;15:461-465.
104. Ross EL, Heizer J, Mixon MA, et al. Development of recommendations
for dosing of commonly prescribed medications in critically ill
obese children. Am J Health Syst Pharm. 2015;72:542-556.
105. Rowe S, Siegel D, Benjamin DK. Gaps in drug dosing for obese
children: a systematic review of commonly prescribed
emergency care medications. Clin Ther. 2015;37:1924-1932.
106. Harskamp-van Ginkel MW, Hill KD, Becker KC, et al. Drug dosing and
pharmacokinetics in children with obesity: a systematic review. JAMA
Pediatr. 2015;169:678.
107. Kendrick JG, Carr RR, Ensom MHH. Pediatric obesity: pharmacokinetics
and implications for drug dosing. Clin Ther. 2015;37:1897-1923.
Young & Korotzer

Table E1. Estimation studies.*
Reference
N
12
Greig et al,
1997
Age Range
75 012 y
Location
Patients
Estimators
Results
Mean bias 0.21 kg; 95% of estimates
within 2 SDs, but wide variation by
individual house ofcers
Accuracy 80%. MPE 6.8%. Performed
better than formula.
Accuracy 73.4%. Mothers 56.1% accuracy
to within 5% vs fathers 40.3%
Accuracy within 20% of actual weight 54%.
Broselow performed better than
physician estimation.
Accuracy within 15% of actual weight:
physician 71%, nurse 60%, parent 84%.
MPE: MD 4.8%, nurse 7%, parent 1.3%
Accuracy within 50% of actual weight:
82.5%
UK
ED
ED senior house ofcers
Lefer and Hayes,13 1997
117 05 y
USA
ED
Parent
Goldman et al,14 1999
233 Not specied
Israel
ED
Parent
Molyneux et al,15 1999
142 Most 824 mo
Malawi
Clinic
Physicians (clinic)
Harris et al,16 1999
100 08 y
USA
ED
Parent, triage nurse,

emergency physician
Vilke et al,18 2001
Krieser et al,27 2007
80 Standardized
USA
Out-of-hospital Paramedics (20 total)
patients: 4.5, 9.5,
10.5, 17.3 kg
410 111 y
Australia ED
Parent
Partridge et al,37 2009
812 020 y
Rosenberg et al,43 2011
372 014 y
Trakulsrichai et al,50 2012 595 012 y
Lim et al,58 2013
179 018 y
Badeli et al,73 2015
238 110 y
Accuracy 78%. Mean bias 0.6 kg.

Performed better than Broselow and
formulae.
USA
ED
Parent or legal guardian, Accuracy 79% parents, 83% legal
triage nurse
guardians, 55% nurses
USA
ED
Emergency physicians,
Accuracy physician 43%, hybrid 55%. MPE
hybridphysician
physician 16.2%, hybrid 11.3%. Broselow
estimate after knowing
alone performed better than physician or
results of Broselow
hybrid estimate.
Thailand ED and clinic Family member
Accuracy 85.21%. Mean bias 0.262 kg.
Performed better than Broselow, weight
for length growth chart.
USA
Out-of-hospital Paramedics
Accuracy within 20% of actual weight
82.4%
Iran
Clinic
Pediatrician, parent
MPE pediatrician 0.17%, parent 0.63%.
Estimates were better than formulae.
MPE, Mean percentage error[(estimated weightactual weight)/actual weight]100.

*Accuracy dened as within 10% of actual weight unless otherwise specied. Mean biasmean estimated weightmean actual weight. Negative values for MPE and mean bias
indicate underestimation of actual weight.
451.e1 Annals of Emergency Medicine
Reference
Lefer and
Hayes,13 1997
Black et al,19
2002
Age Range
Location
Patients
Formulae Studied
Other Methods
Studied
USA
ED
Lefer
None
495 1 mo18 y
Australia
ED
APLS 2001, Traub-Johnson,

Traub-Kichen
Argall et al,21
2003
300 110 y
UK
ED
APLS 2001, Argall
Theron et al,22
2005
909 010 y
New Zealand
ED
APLS 2001, Lefer, Shann,

Theron
Varghese et al,25
2006
500 1 mo12 y
India
Clinic
APLS 2001, Argall, Nelson
17,244 110 y
UK
ED
70,181 014 y
Australia
ED
APLS 2001, LuscombeOwens

Best Guess
410 111 y
Australia
ED
APLS 2001, Argall, Best

Guess, Luscombe-Owens
1,843 014 y
Australia
ED
APLS 2001, ARC, Best

Guess
UK
Clinic
APLS 2001
Broselow, DWEM, MPE APLS 4.7% to 42%,

Oakley
depending on weight category;
Traub-Johnson 2.5% to 15%,
Traub-Kichen 0.7% to 16%.
Broselow and lengthhabitus
(DWEM) method performed
better than formulae.
Broselow
Mean bias 3.52 kg. New formula
derived (Argall). Broselow
performed slightly better than
APLS.
Broselow, Oakley MPE APLS 5.12% to 11.13%,
Lefer 0.52% to 11%, Shann
13.9% to 3.65%, depending on
ethnicity. Shann best for Pacic
islanders, Euro, and Maori; Lefer
best in Asian/Indians. New
formula derived (Theron).
Broselow
Mean bias APLS 2.23 to 2.26 kg,
Argall 2.38 to 4.05 kg, Nelson
0.69 to 5.20 kg, depending on
weight group. Broselow
performed better than formulae.
None
MPE APLS 18.8%, new formula
derived: MPE 2.48%
None
New formula derived, within 0.6 to
0.7 kg of regression line (Best
Guess)
Parent estimate, Accuracy Best Guess 42%, Argall
Broselow
37%, APLS 34%, LuscombeOwens 45.4%. Mean bias Best
Guess 0.7 kg, Argall 1.7 kg,
APLS 4.2 kg, Luscombe-Owens
0.66 kg. Parent estimate best
and Broselow next best; both
None
MPE APLS 12.1% to 19.9%, ARC
12.1% to 12.4%, Best Guess
2.6% to 7.7%, depending on age
group
UK growth chart MPE 12%. Length-based method
using growth charts performed
better than formula.
Thompson et al,31
2007
Sandell and
Charman,34
2008
544 011 y
Accuracy 46%; MPE 13.6%
n/a
Traub-Kichen
Argall*
Shann best overall

except for Asian/
Indian
APLS 2001
Luscombe-Owens*
n/a
Luscombe-Owens,
Best Guess
Best Guess
n/a
Annals of Emergency Medicine 451.e2
117 060 mo
Luscombe and
Owens,2 2007
Tinning and
Acworth,30
2007
Krieser et al,27
2007,
Kelly et al,32
2007,
Kelly et al,40
2011
Best Formula
Method
Results
Young & Korotzer
Table E2. Formula studies.
Reference
Age Range
Location
Patients
Formulae Studied
Other Methods
Studied
1,011 010 y
USA
Inpatients
Lefer, Theron
Broselow
Casey and
Borland,38
2010
1,235 014 y
Australia
ED
APLS 2001, Best Guess
Broselow
Cattermole
et al,39 2010
1,370 111 y
China
Schools
APLS 2001, Cattermole

(based on mid upper-arm
circumference)
Foot length,
Broselow
Cattermole
et al,41 2011
1,248 110 y
China
Schools
APLS 2001, ARC, Argall, Best None

Guess, CAWR, CAWR2,
Luscombe- Owens,
Nelson, Shann, Theron,
Tintinalli
UK
ED
None
South Africa
ED

APLS 2001, Best Guess,
Luscombe-Owens
UK
Assessment unit

Guess, ERC, LuscombeOwens
None
Trinidad and
Tobago
ED
Ali, APLS 2011, LuscombeOwens
None
Korea
National survey
APLS 2001, Best Guess,

Lefer, Nelson, Shann,
Park
Broselow
Luscombe et al,44
2011
Geduld et al,45
2011
Seddon et al,47
2012
Ali et al,49 2012
93,827 116 y
2,832 110 y
599 1 mo12 y
1,723 15 y
Park et al,51 2012 124,094 014 y
Broselow
MPE Lefer 44% to 24%,

depending on weight group;
Theron 10% to 106%; Theron
performed better in all except
<10 kg. Broselow outperformed
formulae in younger children.
MPE APLS 12.61% to 17.36%,
Best Guess 1.69% to 4.5%,
depending on age group. Best
Guess most accurate, Broselow
most precise.
Accuracy APLS 39%, Cattermole
44.2%. MPE APLS 13.4%,
Cattermole 2.9%. Broselow
performed better than either
formula.
Accuracy APLS 41.6%, ARC 42.1%,
Argall 34.6%, Best Guess 31.9%,
Luscombe-Owens 30.6%, Nelson
42.4%, Shann 42.7%, Theron
24.8%, Tintinalli 37.6%. Derived
new formulae CAWR (accuracy
36.1%) and CAWR2 (38.7%).
MPE APLS 33.4%, LuscombeOwens 6.9%
MPE APLS 3.27%, Best Guess
15.41%, Luscombe-Owens
12.36%. Broselow performed
MPE APLS 0.42% to 9.4%,
depending on age group, Argall
3.5% to 6.6%, Best Guess 1.8%
to 4.7%, ERC 9.4% to 21.8%,
Luscombe-Owens 0.12% to 0.5%
Accuracy APLS 45.6%, LuscombeOwens 42.3%. MPE APLS 5.8%,
Luscombe-Owens 5.0%. Derived
new formula (Ali) with accuracy
47.5%, MPE 3.1%.
MPE APLS 11.48%, Best Guess
4.97%, Lefer 1.74%, Nelson
9.98%, Shann 8.6%. Derived
new formula (Park) with MPE
0.88%. Broselow MPE 4.80%.
Best Formula
Method
Theron
Best Guess
Cattermole*
CAWR* (considered
best because
lowest mean bias)
Luscombe-Owens
APLS 2001
Luscombe-Owens
Ali,* APLS
Park,* Lefer
Young & Korotzer
So et al,35 2009
Results
Table E2. Continued.
1,938 2 mo16 y
USA
NHANES data
APLS 2001, ARC, Argall, Best Broselow

Guess, Cattermole, Lefer,
Luscombe-Owens, Nelson,
Shann, Theron, TraubJohnson, Traub-Kichen
Egypt
Oncology clinic
patients
APLS 2001, GarwoodMcEwen, Shann
None
508 116 y
House et al,55
2013
967 2 days14 y Kenya
Clinic
APLS 2001, Nelson
Broselow
Abdel-Rahman
et al,56 2013
976 2 mo16 y
USA
Day care
establishments
and hospital
APLS 2001, LuscombeOwens, Nelson
Broselow, Mercy
Loo et al,57 2013
875 110 y
Singapore
ED
Broselow
Australia
Hospital
APLS 2001, APLS 2011,

Best Guess, LuscombeOwens
Broselow
USA
ED
APLS 2001, nger counting, Broselow

Luscombe-Owens
Graves et al,61
2014
Young et al,62
2014
37,091 014 y
207 19 y
Best method varied

according to age,
habitus.
Cattermole best
overall.
Garwood-McEwen,
Shann
APLS
Nelson
APLS
Best Guess
Finger counting or
Luscombe-Owens
Hegazy and
Taher,54 2013
Accuracy, MPE APLS 17.8%,

14.88%, ARC 27.5%, 16.84%,
Argall 19.8%, 4.55%, Best
Guess 31.2%, 0.98%, Cattermole
15.5%, 3.51%, Lefer 24.8%,
5.52%, LuscombeOwens
20.2%, 0.82%, Nelson 25.9%,
7.69%, Shann 26.3%, 17.38%,
Theron 19.6%, 9.64%, TraubJohnson 45.2%, 7.13%, TraubKichen 45.3%, 9.48%. Broselow
37.4%, 6.05%, Mercy 78.6%,
0.46%
Accuracy APLS 33%, GarwoodMcEwen 36%, Shann 36%. MPE
APLS 8.5%, Garwood-McEwen
8.6%, Shann 8.5%. Mean bias
APLS 3.9 kg, Garwood-McEwen
1.3 kg, Shann 2.0 kg.
MPE APLS 5.2%, Nelson 10.4%.
formulae.
Accuracy APLS 34.4%, LuscombeOwens 29.7%, Nelson 43%.
formulae. Mercy performed best
of all methods.
Accuracy APLS 45.7%, LuscombeOwens 37.7%. MPE APLS 7.6%,
Luscombe-Owens 7.4%.
formulae.
Accuracy APLS 2001 29%, APLS
2011 25.1%, Best Guess 24.6%,
Luscombe-Owens 25.5%. Mean
bias APLS 2001 5.76 kg, APLS
2011 1.14 kg, Best Guess 0.86
kg, LuscombeOwens 2.18 kg.
Broselow more accurate but
higher mean bias.
Accuracy APLS 33%, nger counting
59%, Luscombe-Owens 52%.
Mean bias APLS 3.8 kg, nger
counting 1.8 kg, LuscombeOwens 0.2 kg. Finger counting
and Luscombe-Owens performed
similarly to Broselow.
Young & Korotzer
Abdel-Rahman,8
2012
Reference
Dicko et al,63
2014
Age Range
473 2 mo16 y
Location
Patients
Formulae Studied
Other Methods
Studied
Mali
Village
APLS 2011, ARC, Nelson
Broselow, Mercy
Best Formula
Method
Results
Accuracy APLS 15%, ARC 40.8%,
Nelson 23.5%. MPE APLS 23.6%,
ARC 9.6%, Nelson 19.8%. ARC
performed similar to Broselow.
Mercy performed best of all
methods.
Accuracy APLS 54%, LuscombeOwens 89.7%, Theron 91%. Mean
bias APLS 9.3 kg, LuscombeOwens 3.4 kg, Theron 7.1 kg.
Derived new formula (Michigan)
accuracy 92%, mean bias 3.6 kg.
MPE 0.8% to 25.4%, depending on
age group. Derived multiple new
formulae.
MPE APLS 0.09%, Argall 3.38%,
Best Guess 16.43%, LuscombeOwens 11.13%, Nelson 1.15%.
formulae or growth charts.
MPE Best Guess 10.11% to
30.67%, Nelson 0.59% to
10.11%, depending on age group
ARC
n/a
Luscombe-Owens
10,488 212 y
USA
Preoperative,
31.8% obese
APLS 2001, LuscombeOwens, Theron
None
Flannigan et al,66
2014
10,081 015 y
UK
PICU
APLS 2011
None
Allison and
Norton,67 2014
2,012 05 y
Aboriginal
Australia
Clinic

Guess, Luscombe-Owens,
Nelson
Broselow, WHO
and UK growth
charts
Omisanjo et al,70
2014
2,754 1 mo11 y
Nigeria
Best Guess, Nelson
None
Eke et al,69 2014

Skrobo and
Kelleher,71
2015
Badeli et al,73
2015
370 112 y
3,155 115 y
Nigeria
Ireland
Day care
establishments,
schools,
immunization
centers
Clinics
ED, wards
Nelson
None
None
Mean bias 1.15 kg

MPE APLS 20.3%, LuscombeOwens 4%
238 110 y
Iran
Clinic
APLS 2001, Cattermole,

Lefer, Theron, TraubJohnson, Traub-Kichen
DWEM, Oakley,
estimation
Young et al,74
2015
207 19 y
Philippines
Clinic
APLS 2001, APLS 2011,

Best Guess, nger
counting, LuscombeOwens
Broselow
Britnell and
KoziolMcLain,75
2015
376 510 y
New Zealand
School
APLS 2001, Shann, Theron
Broselow
MPE APLS 11.91%, Cattermole

Traub-Johnson and
25.48%, Lefer 13.94%, Theron
Traub-Kichen
24.96%, Traub-Johnson 4.56%,
(length based)
Traub-Kichen 5.51%. Estimation
by parent or pediatrician
Mean bias APLS 2001 1.1 kg, APLS APLS 2001
2011 4 kg, Best Guess 5.3 kg,
nger counting 3.1 kg, LuscombeOwens 5.1 kg. Broselow
Accuracy APLS 39.1%, Shann
None
45.7%, Theron 28.7%. Mean bias
APLS 7.8 kg, Shann 7.7 kg,
Theron 6.5 kg. Broselow
Michigan*
Luscombe-Owens
n/a
APLS, Nelson
Neither
Young & Korotzer
Ackwerh et al,65
2014
Table E2. Continued.
324 1 mo12 y
USA
ED, 32%
overweight or
obese
Broselow,
PAWPER
Talib et al,79
2015
318 018 y
USA
Research center,
Downs
syndrome
Broselow, Mercy
Batmanabane
et al,80 2015
375 2 mo16 y
India
Not specied,
single center
APLS 2001, ARC, Argall, Best Broselow, Mercy

Guess, Lefer, LuscombeOwens, Nelson, Shann,
Theron, Traub-Johnson,
Traub-Kichen
Udoh and
Moses,81 2015
114 114 y
Nigeria
Clinic
APLS 2001, LuscombeOwens, Argall
None
Clark et al,83
2016
583 660 mo
South Sudan
Malnutrition
screening data
gathered in
villages; 37%
severely
malnourished
Nelson, APLS 2011, Best

Guess, Broselow
Broselow
Accuracy APLS 36.4%, Cattermole

24.1%. Mean bias APLS 1.32
kg, Cattermole 4.43 kg. Broselow
and PAWPER performed slightly
Accuracy to within 20% of actual
weight APLS 61%, Cattermole
40%. MPE APLS 7.8%, Cattermole
24.1%. Mercy performed better
than formulae and Broselow.
Accuracy APLS 17%, ARC 23%,
Argall 10%, Best Guess 10%,
Lefer 11%, Luscombe-Owens
6%, Nelson 18%, Shann 22%,
Theron 7%, Traub-Johnson 29%,
Traub-Kichen 28%. MPE APLS
13.9%, ARC 18.1%, Argall 31.5%,
Best Guess 41.3%, Lefer 27.8%,
Luscombe-Owens 38%, Nelson
28.2%, Shann 18.4%, Theron
51.4%, Traub-Johnson 11.1%,
Traub-Kichen 10%. Mercy
performed better than formulae
and Broselow.
MPE APLS 1.91%, LuscombeOwens 2.24%, Argall 1.24%. APLS
underestimated in >5-y-olds
Accuracy Nelson 2.7% to 30.4%,
APLS 2011 4.6% to 30.8%, Best
Guess 0.9% to 15.4%, depending
on degree of malnutrition
(severeless accurate). Broselow
not better than formulae.
APLS
APLS
Young & Korotzer
Chavez et al,78
2015
Traub-Johnson,
Traub-Kichen
Argall
Nelson, APLS 2011
This formula performed best in this study because it was derived from the data in the study and is not an external validation.
*Accuracy is dened as within 10% of actual weight unless otherwise noted. MPE[(estimated weightactual weight)/actual weight]100. Mean biasmean estimated weightmean actual weight. Negative values for MPE and
mean bias indicate underestimation of actual weight. BroselowBroselow tape, a length-based method. MercyMercy tape or method, a method based on mid upper-arm circumference and humeral length. DWEMa lengthbased method with habitus adjustment. PAWPERa length-based method with habitus adjustment. Best method of multiple methods reported only if multiple formulae were tested.
Reference
Lubitz et al,4 1988
N
1,002
Tape
Results
1 wk12 y
Age Range
ED and clinic
Patients
Multicenter USA
Location
Measured or Virtual
Measured
Original 1998

Performed best in <25 kg.
Correlation coefcient0.974. Performed
best in <30 kg.
Accuracy 79% within 20% of actual weight.
Performed best in children 414 kg.
Accuracy 69.5%. Mean bias 2.3 kg in
children >25 kg. Performed best in
1025 kg.
MPE 0.4% to 0.6% in <25 kg, 6.4% in
>25 kg
Performed better in younger children.
Mean bias 2.74 kg. Correlation coefcient
0.85.
MPE 3.91% to 5.87% in Euro and Asian/
Indian, 11.02% to 11.16% in Maori
and Pacic Islander
Accuracy 60% for 1998 tape, 55.3% for
2002A tape. MPE 5.6% for 1998 tape,
3.9% for 2002A tape.
Mean bias 0.081.22 kg. Correlation
coefcient 0.974.
MPE 7.12% to 9.91%, depending on
weight group. Worse performance in
<10 kg.
Accuracy 61%. Mean bias 1.8 kg. Worse
performance in higher weights.
Hughes et al,10 1990
163
010 y
ED and clinic
United Kingdom
Measured
1998
Molyneux et al,15 1999
142
Hospital, clinics
Malawi
Measured
Kun et al,17 2000
909
Most between 8
and 24 mo
7 days12 y
ED
China
Measured
Modied for
Malawi
1998
Black et al,19 2002
495
1 mo18 y
ED
Australia
Measured
1998
Hofer et al,20 2002
585
6 mo11 y
Switzerland
Virtual
1998
Argall et al,21 2003
300
110 y
Anesthesia
patients
ED
United Kingdom
Virtual
Not specied
Theron et al,22 2005
909
010 y
ED
Maori, New Zealand
Measured
Not specied
7,813
011 y
Schools and clinic
USA
Virtual
1998, 2002A
Nieman et al,24 2006
Varghese et al,25 2006
500
1 mo12 y
Clinic
India
Virtual
2002A
DuBois et al,26 2007
400
1 mo19 y
ED
USA
Virtual
Not specied
Krieser et al,27 2007
410
011 y
ED
Australia
Virtual
1998
Jang et al,28 2007
665
115 y
Korea
Virtual
Not specied
Hashikawa et al,29 2007
544
USA
Virtual
2002B
Ramarajan et al,33 2008
548
Birth, 46 y,
1012 y
1 mo12 y
Anesthesia
patients
Clinic
Clinic
India
Measured
Not specied
1,011
010 y
Inpatients
USA
Virtual
Not specied
Casey and Borland,38 2010
1,235
014 y
ED
Australia
Virtual
Not specied
Cattermole et al,39 2010

Knight et al,42 2011
Rosenberg et al,43 2011
Geduld et al,45 2011
Bourdeau et al,46 2011
Milne et al,6 2012
1,391
657
372
2,832
243
6,361
111 y
016 y
014 y
110 y
09 y
018 y
Schools
Trauma patients
ED
ED
Clinic
ED, clinic, schools
Hong Kong
USA
USA
South Africa
Canada First Nations
Canada
Virtual
Virtual
Measured
Virtual
Virtual
Virtual
1998
2007B
2007B
1998
Not specied
2002A
Young & Korotzer
So et al,35 2009
Correct color zone: 100% at birth, 70% at

46 y, 40.6% at 1012 y
Accuracy 33.5% to 52.6% (higher for <10
kg, lowest for >18 kg). MPE 2.4% to
12.9%. With 10% adjustment (subtract
10% from estimated weight for children
>10 kg), accuracy 52.6% to 77%.
MPE 0.2% to 38%, depending on weight
group. Worse performance in >25 kg.
Accuracy 87%91% to within 20% of actual
weight. MPE 5.28% to 7.24%,
depending on weight group.
Accuracy 53%
Correct color zone: 46.9% (underestimates)
Accuracy 63%
Accuracy 64.2%; MPE 0.89%
Accuracy 56.3%, MPE 7.1%, mean bias
1.621 kg
Table E3. Broselow tape studies.*
Trakulsrichai et al,50 2012

Park et al,51 2012
Heyming et al,53 2012
Abdel-Rahman,8 2012
House et al,55 2013
Wells et al,7 2013
145
595
124,095
572
1,938
967
453
014 y
Trauma patients
USA
Measured
Not specied
012 y
014 y
<145 cm tall
ED and clinic
National survey
Out-of-hospital
and ED
NHANES data
Clinic
ED
Thailand
Korea
USA
Measured
Virtual
Measured
Not specied
Not specied
Not specied
USA
Kenya
Africa
Virtual
Measured
Measured
Not specied
2007B
Not specied
Hospital, day care

establishments
ED
USA
Virtual
2007B
Singapore
Virtual
2007B
2 mo16 y
2 days14 y
1 mo12 y
Abdel-Rahman et al,56 2013
976
2 mo14 y
Loo et al,57 2013
875
110 y
Abdel-Rahman et al,59 2013
624
2 mo16 y
37,091
207
473
Accuracy 50%, MPE 8.4%, mean bias

2.6 kg
Accuracy 56.13%
MPE 4.8%, mean bias 1.22 kg
Mean bias1.1 kg; correlation coefcient
paramedic 0.92
MPE 2.2%
Accuracy 63.6%; MPE 3.8%; mean bias
0.9 kg
Accuracy 53.5%
0.6 kg
1.3 kg
Accuracy 49.4%; mean bias 3.08 kg
Accuracy 56%; mean bias 1.4 kg
1.5 kg
MPE 0.35%
Accuracy 58%; MPE 3.56%; mean bias
0.87 kg
Accuracy 55.3%, mean bias 0.26 kg, 40%
off by 1 color zone, 3.7% off by 2 zones
Mean bias 0.6 kg
MPE 8.49%. Mean bias 1.23 kg. 33%
86.6% correct color zone, depending on
color zone. After applied 8% correction,
51%97.8% correct color zone. Higher
color zonesless accurate.
Virtual
2007B
Australia
USA
Mali
Virtual
Virtual
Virtual
2007B
Not specied
Not specied
2,102
3,896
05 y
014 y
Clinics
Clinics
Aboriginal Australia
Thailand
Virtual
Virtual
2007B
2007A
815
012 y
ED
Mexico
Measured
Not specied
207
376
1,185
19 y
510 y
1 mo12 y
Clinics
School
Clinics
Philippines
New Zealand
India
Virtual
Measured
Measured
2011A
2011
2007B
Chavez et al,78 2015
324
1 mo12 y
USA
Virtual
Not specied
Talib et al,79 2015
318
018 y
USA
Virtual
2007B
Accuracy 76%; MPE 11.9%; mean bias

4.0 kg
Batmanabane et al,80 2015

Clark et al,83 2016
375
583
2 mo16 y
660 mo
ED, 32%
overweight or
obese
Downs
syndrome,
research center
Not specied
Village, 37%
severely
malnourished
India
South Sudan
Virtual
Virtual
Not specied
2011A
Accuracy 28%, MPE 10.8%

Accuracy 28.2% if not malnourished, 5.6%
if severely malnourished
Allison and Nelson,67 2014

Chiengkriwate et al,68 2014
Khouli et al,72 2015
Young et al,74 2015
Britnell and Koziol-McLain,75 2015
Asskaryar and Shankar,77 2015
*Measured: A Broselow tape was placed next to a supine or standing child and measured. Virtual: Childs length or height as recorded in chart was used to determine Broselow estimation. Accuracy is dened as within
10% of actual weight unless otherwise specied. MPE[(estimated weightactual weight)/actual weight]100. Mean biasmean estimated weightmean actual weight. Negative values for MPE and mean bias indicate
underestimation of actual weight.
Multicenter USA
014 y
19 y
2 mo16 y
Clinics and
inpatient
Hospital
ED
Village
Graves et al,61 2014

Young et al,62 2014
Dicko et al,63 2014
Young & Korotzer
Sinha et al,48 2012
Reference
Garland et al,9 1986
258 <18 y
Age Range
USA
Location
ED, clinic
Patients
Black et al,19 2002
495 1 mo18 y
Australia
ED
DuBois et al,26 2007
400 1 mo19 y
USA
ED
Yamamoto et al,36
2009
542 Not specied

USA
(2.5130 kg)
ED
Abdel-Rahman,8 2012 1,938 2 mo16 y
USA
NHANES data
Abdel-Rahman et al,56
2013
Abdel-Rahman et al,59
2013
976 2 mo16 y
USA
624 2 mo16 y
USA
Hospital, day care

establishments
Clinics, inpatient
Wells et al,7 2013
453 1 mo12 y
South Africa ED
Dicko et al,63 2014
473 2 mo16 y
Mali
Erker et al,64 2014
n/a
112 y
Village
WHO and
n/a
CDC data
238 110 y
Iran
Clinic
Talib et al,79 2015
318 018 y
USA
Research center
Downs syndrome
patients
Not specied, single
center
ED
Batmanabane et al,80
375 2 mo16 y
2015
Garcia et al,76 2015
1,698 Not specied,
46150 cm
Chavez et al,78 2015
324 1 mo12 y
India
USA
USA
ED, 32% overweight

or obese
Results
Mercy (as described above), made into a 2D and

3D tape used to measure mid upper-arm
circumference and humeral length
PAWPER tape: gives WHO weight for length by 5
habitus: very thin (fth percentile), thin (25th
percentile), average (50th percentile), heavy
(75th percentile), obese (95th percentile)
Mercy (as described above)
Tall and thin: 2 (age in years)6

Normal: 3 (age in years)6
Tiny and thick: 4 (age in years)6
DWEM (as described above)

PAWPER (as described above)
PAWPER (as described above)
Accuracy 76.4% for 2D tape, 65.1% for 3D tape. Mean

bias 0.28 kg for 2D tape, 0.22 kg for 3D tape.
Accuracy PAWPER 89.2%, Broselow 63.6%. MPE
PAWPER 0%, Broselow 3.8%. Mean bias PAWPER
0.1 kg, Broselow 0.9 kg.
Accuracy 71.5%. MPE 1.6%. Mean bias 0.06 kg.
Performed better than Broselow or age-based
formulae.
Correlation with actual weight 0.97 to 0.99
MPE 8.74%. Parent and MD estimates, length-based

formulae performed better than DWEM. Age-based
formulae performed worse than DWEM.
Accuracy to within 20% of actual weight 88%. MPE
3.9%. Mean bias 1.4 kg. Performed better than
Broselow, formulae.
Accuracy 70%. MPE 1.5%. Performed better than
Broselow, formulae.
Accuracy 63%. Mean bias 1.09 kg. Performed better
than Broselow, age-based formulae, MAC formula
weight in kg(MAC in cm10)3
MAC, Midarm circumference.

*Accuracy dened as within 10% of actual weight unless otherwise specied. MPE[(estimated weightactual weight)/actual weight]100. Mean biasmean estimated weightmean actual weight. Negative values for MPE
and mean bias indicate underestimation of actual weight.
Young & Korotzer
Badeli et al,73 2015
Methods
DWEM: standard growth curves results of weight for Accuracy 61%. Length/height and habitus accounted
length for 3 habitus: slim (fth percentile), average
for 87% of the variance of weight.
(50th percentile), heavy (95th percentile)
MPE 3.9% to 7%, depending on weight group.
Performed better than age- and length-based
formulae, similar to Broselow.
MPE 6.73% to 1.79%, depending on weight group.
Slight overestimate in <20 kg, underestimates in
>20 kg. Performed better than Broselow.
Investigator assigned one of 5 habitus for <3 y
Habitus-specic formulae performed better than
and one of 6 for >3 y. Regression formulae
Broselow in accuracy of epinephrine dosing
derived for each habitus to predict weight by length.
Derivation and validation of Mercy method; table
based on mid upper-arm circumference and
humeral length
Accuracy 77%
Table E4. Studies using length-based methods with adjustment for body habitus.*
Young & Korotzer
Table E5. Other methods.*

Reference
N
11
Haftel et al,
1990
Age Range
Location
Patients
100 2180 mo
USA
Anesthesia
Bavdekar et al,23 2006
500 024 mo
India
Clinic
Sandell and Charman,34

2009
544 011 y
UK
Clinic
Cattermole et al,39 2010 1,370 111 y

China
Trakulsrichai et al,50
595 012 y
Thailand
2012
Elgie and Williams,52
188 10 wk10 y UK
2012
School
Clinic
Young et al,62 2014
USA
ED
2,102 05 y
Aboriginal
Australia
Clinics
207 19 y
Philippines
Clinics
Allison and Norton,67

2014
Young et al,74 2015

Huang et al,82 2015
207 19 y
39 618 y
USA
ED
Method
Results
Regression formulae based on SL

and LWweight of legs placed
in a sling at 45-degree angle.
Wt0.312 (SL in cm)13.948.
Wt5.176 (LW)3.487.
FL: formula-derived wt in
kg5.15(1.35FL in cm)
UK growth charts with weight for
age and weight for length
Foot length
National Thai weight for height
growth chart
Age-based formulae (APLS 2001,
APLS 2011, Luscombe-Owens)
applied to the age range of
clothing size on clothing label
Handtevy or nger-counting
mnemonic: 5 ngers are 1, 3, 5,
7, 9 y, corresponding to 10, 15,
20, 25, 30 kg
Sandell UK growth charts, WHO
growth charts
Handtevy or nger counting (as

described above)
Not specied Age and 3 facial feature
measurements (authors propose
using facial recognition software
in future)
Accuracy LW 73.7%, SL 61.2%. MPE

LW 8.96%, SL 12.84%.
Correlation coefcient LW 0.95,
SL 0.867.
Correlation coefcient 0.88
MPE weight for age 2%, weight for
length 4%. Weight for age had
wider limits of agreement, so
weight for length best method.
Accuracy 51.43%; mean bias
0.648 kg
APLS (2001 and 2011) formula with
average age from clothes label
more accurate than with actual
age
Performed as well as Broselow.
MPE Sandell 12.36%, WHO

1.47%. Broselow performed
best. APLS and Nelson formulae,
WHO growth charts next best.
Mean bias 3.1 kg. Broselow
performed better.
SL, Supine length; LW, hanging leg weight; FL, foot length.
*Accuracy dened as within 10% of actual weight unless otherwise specied. MPE[(estimated weightactual weight)/actual weight]100. Mean biasmean estimated
weightmean actual weight. Negative values for MPE and mean bias indicate underestimation of actual weight.

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PEDIATRICS/SYSTEMATIC REVIEW/META-ANALYSIS

Weight Estimation Methods in Children:

to the childs age, such as the Advanced Pediatric Life

Weight Estimation Methods in Children

Editors Capsule Summary

What is already known on this topic

Because concern has increased in regard to underestimation

Young & Korotzer

engine Google Scholar, and the PubMed and Google Scholar

Young & Korotzer

Weight Estimation Methods in Children

Records idened through

Several studies investigated patient and provider abilities

Addional records idened

Records screened without regard to

Full-text arcles assessed

Full-text arcles excluded,

Annals of Emergency Medicine 443

Young & Korotzer

444 Annals of Emergency Medicine

EMS, Emergency medical services; DWEM, Devised Weight Estimate Method.

DWEM, Mercy, PAWPER

Method uses published growth data (eg, NHANES,

Foot length, facial measurements,

Parents/legal guardians highly accurate, others

Table 1. Primary methods of weight estimation studied.

Weight Estimation Methods in Children

children. When applied to children from geographic areas

Luscombe and Owens,2 2007

Berhman et al,3 2004

Theron et al,22 2005

Traub and Johnson,88 1980

Traub and Kichen,89 1983

Garwood and McEwen,91 2012

Tintinalli et al,92 2000

Underestimates weight in average or obese

Underestimates weight in average or obese

Same formula as APLS 2001

Overestimates in young children, underestimates

Performs better than other formulae for larger

2.5 (age in years)8

Trinidad and Tobago

This formula studied only in this study

This formula studied only in this study

Mnemonic: 5 ngers of hand1, 3, 5, 7, 9 y,

Weight Estimation Methods in Children

Annals of Emergency Medicine 445

Other formulae less commonly studied

Formula for Weight in Kilograms

Commonly studied formulae

Young & Korotzer

Volume 68, no. 4 : October 2016

Table 2. Formulae based on age, length or height, or midarm circumference.

Weight Estimation Methods in Children

accuracy of 70% to 77%.8,56,59 Studies of the Mercy

Young & Korotzer

Unfortunately, with the exception of that conducted by

Young & Korotzer

between 46 and 143 cm tall. Finally, the Broselow tape is

Weight Estimation Methods in Children

different body habitus.56,59,63,79,80 A disadvantage is that

Young & Korotzer

Weight Estimation Methods in Children