Use of the Broselow Tape May Under Resuscitate Children

[jwiley40]

To all here:

I was looking up information on IO infusion for peds and ran across a short paragraph from 2006 that says the Broselow Tape may under-resuscitate children. Here is that paragraph:

Registered nurse Carolyn Nieman (In Memoriam) discovered that sometimes motherhood is the mother of invention. Ms. Nieman, who served as an ACNP/flight nurse specialist for Metro Life Flight and faculty at Case's FPB School of Nursing, presented her project “Use of the Broselow Tape May Under Resuscitate Children,” for which she shared credit with seven other researchers at the 2003 Research ShowCASE. While watching her then-thirteen-year-old daughter and ten-year-old son perform at a school concert, she first thought of the idea that she displayed at the showcase. Soon afterward, she began devising a way to improve on the “Broselow Tape” method traditionally used in emergency medical situations involving children requiring resuscitation. The method is used to estimate medication dosing and equipment sizing based on a child’s age and body size.

“I always thought my kids were normal size, but that night they seemed so much smaller than everyone else on stage,” she said. “So when I came to work, I started thinking there’s no way that the Broselow Tape can be accurate anymore, and it became more clear to me everywhere I went that kids seemed bigger and bigger.” She enlisted the help of several other flight nurses she worked with to research the current accuracy of the Broselow Tape, which had never been validated in a pediatric population, according to Ms. Nieman. The team worked to correlate the device against a large sample of children.

Their research analyzed measurements of about 1,150 children ages 5 to 11 from several Greater Cleveland schools, as well as the database numbers for the MetroHealth System’s measurements of children from birth to age 11 taken during annual well-child visits. The team collected enough height and weight data to conclude that less than fifty percent of pediatric patients today would receive an accurate dosage estimate based on the Broselow system, especially children who are older or heavier. Ms. Nieman’s research group is in the process of completing its research paper and getting it published, which they hope to do this summer. “We want to get the word out to people in emergency medical systems, fire departments, emergency rooms, and so on, so they can determine what they want to do with the information,” she says.

Nieman CT, Manacci CF, Super DM, Mancuso C & Fallon WF. (2006). Use of the Broselow tape may result in underresuscitation of children. Academic Emergency Medicine, 13, 1011-1019.

I have looked on Google, Bing and in medical search engines trying to find more information. If anyone can point me in the right direction, I would be most appreciative. I would like to think that when I have to resuscitate a pediatric patient, that I use every tool in my tool-kit to do it.

[Just Plain Ruff]

Its been suppressed by the people who brought you the broselow tape. They don't want you to know that their coveted tape may under-treat some kids. This previous statement only applies if you believe in conspiracy theories.

But if you were to take my son's height and then take his weight, you would under-dose his resus drugs by about 20 percent. I say that's not good juju if you ask me.

[jwiley40]

Yikes! That's a problem. And that's why I put this out there. I can't seem to find it anywhere, the full study with all the results and data. But I have to agree with the information presented in the paragraph. However, I have to follow the protocols of my service and the new service I'm getting ready to work for. I would like to be able to present the information to my new supervisors.

[Arctickat]

http://www.ncbi.nlm.nih.gov/pubmed/17015417

http://pediatrics.aappublications.org/content/123/6/e1045.full.pdf

http://onlinelibrary.wiley.com/doi/10.1197/j.aem.2006.06.042/pdf

https://indianpediatrics.net/oct2006/oct-889-894.htm

https://fellowiki.wikispaces.com/file/view/comparison+of+estimate+and+broselow.pdf

[island emt]

about fifteen years ago we had the pleasure of hearing directly from Dr Jim Broselow at an EMS seminar. He discussed how they had originally developed the system back in the earl 1980's & how times were changing with the increase in size of peds & young teens in the modern age. He told us to guestimate with the tape and then by our best ability adjust for additional body mass & size.

Lets face it folks: Kids are getting much bigger today than they were back then.

There is an 8 yr old female in the neighborhood who is 50 lbs heavier and taller than my wife. Wife is "normal sized @ 5'4 & 120lbs.

Child has also begun puberty by age 8?? WTF

Plenty of teens outweigh me and I'm not exactly small at 205 lbs, which is 10 lbs more than I weighed when I entered the Navy in 1972

Has to be whats in all the processed foods kids eat now a days.

[jwiley40]

It's either what they're eating OR how much they eat. There is one thing I have learned in all my time working in rural EMs: farm kids always seem to be much bigger than the city kids I have met. I'm not entirely sure if it's a combination of hard work and good old fashioned home cooking, or if it's simply that they eat more than we did as kids. I took care of a fourteen year old boy that was taller and bigger than I was when I joined the Army in 1982! he was longer than my cot!

Arctickat, thank you for the leads! They will be most helpful. You rock!!

To all of the members of this page, if I haven't said it before, I will now: Thank you all! You have always been a source that gives me some seriuos guidence. I still pursue the subject I ask about, but you all give me a better direction. That is where I want to be in the very near future. Even after 7 years, I still have much to learn.