Objective The use of pediatric length-based weight estimation tapes with precalculated drug doses is advocated by major Advanced Life Support organizations, but concerns have been raised on the accuracy of these systems. The objective of this systematic review was to collect, review, evaluate, and create a synthesis of the current literature to establish whether there is high-quality evidence for use of length-based tapes in accurate drug dose administration. A further objective was to compare these tapes with other dosing aids. Methods Eligible studies were identified and analyzed if they were peer reviewed, full text articles containing original data. Studies including any form of length-based precalculated drug dosing methodology in children aged 0 to 18 years were included. Results Eighteen studies met the inclusion criteria. The most studied of the tapes was the Broselow tape in 16 studies (88.9%). When these tapes were used on their own without additional reference material, they produced a substantial number of potentially harmful dosing errors (>20% error). No tape was superior to another. Using the tapes was better than using no dosing aid but was inferior to using both comprehensive drug dosing guides and novel color-coded medication administration systems. Conclusion There was no high-quality evidence that the use of length-based tapes with precalculated drug doses leads to accurate drug dosing. However, comprehensive drug dosing systems were more effective at reducing dosing errors than were length-based tapes on their own. The confounding effect of weight estimation accuracy on drug dosing accuracy has not been sufficiently studied.
Citations
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A Novel Artificial Intelligence-Based Mobile Application for Pediatric Weight Estimation Sungwoo Choi, Sangun Nah, Ji Eun Moon, Sangsoo Han Journal of Clinical Medicine.2025; 14(9): 2873. CrossRef
A Descriptive Analysis of the Reliability of the Broselow Tape for Use in the US Pediatric Trauma Population Ian S. McCullough, Melissa L. Givens, Kelli J. Welter, Hannah L. Gale, Ashley E. Sam, Jonathan Henderson, Michael D. April, Steven G. Schauer Pediatric Emergency Care.2025; 41(8): 587. CrossRef
Objective The primary aim of this study was to prospectively compare the performance of the Broselow tape, Mercy method, pediatric advanced weight prediction in the emergency room extra-long (PAWPER XL) tape, and PAWPER XL mid-arm circumference (MAC) method in estimating the weight of children from a low-income setting. The secondary aim was to analyze the time taken to perform each method.
Methods This analyzed a convenience study sample of 300 children aged 0 to 18 years at the Baragwanath Hospital in South Africa. Weight estimations were obtained using each of the weight estimation systems on each child. These weight estimations were then compared against the actual weight to determine bias, precision, and accuracy of the estimation methods.
Results The PAWPER XL tape and PAWPER XL-MAC methods performed the best and provided estimated weights within 10% of the actual weight in 62.7% and 67.3% of cases, respectively, followed by the Mercy method (56.5%) and Broselow tape (43.9%). The use of MAC improved the accuracy of estimation, especially in heavier and taller children. The median times taken to perform measurements using the Broselow tape, Mercy method, PAWPER XL tape, and PAWPER XL-MAC method were 11.3 seconds, 34.7 seconds, 9.3 seconds, and 33.9 seconds respectively.
Conclusion The PAWPER XL tape and PAWPER XL-MAC methods were the most accurate methods of estimating weight in this group of children. These methods may be considered in preference to the Broselow tape or the Mercy method for emergency weight estimation in low socioeconomic status populations.
Citations
Citations to this article as recorded by
A global perspective on the accuracy of pediatric weight estimation methods in emergency care: A systematic review Irrintzi Fernández-Aedo, Sendoa Ballesteros-Peña, Sandra Tobar-Cabrera, Gorka Vallejo-De la Hoz, Julia Fernandez-Alonso The American Journal of Emergency Medicine.2026; 102: 81. CrossRef
Artificial intelligence for weight estimation in paediatric emergency care Iraia Isasi, Elisabete Aramendi, Erik Alonso, Sendoa Ballesteros-Peña BMJ Paediatrics Open.2025; 9(1): e002891. CrossRef
Accuracy of Paediatric Advanced Weight Prediction in the Emergency Room-eXtra Length (PAWPER XL) Tape in Estimation of Body Weight in Pediatric Emergencies Tejavath K Singh, Kafeel Khan, Suresh R J Thomas Cureus.2025;[Epub] CrossRef
Medicines management in children and young people: pharmacokinetics, drug calculations and off-label drug use Kate Davies Nursing Children and Young People.2024; 36(6): 34. CrossRef
An augmented reality mobile application for weight estimation in paediatric patients: A prospective single-blinded cross-sectional study Sangun Nah, Sungwoo Choi, Nayeon Kang, Kyung Yoon Bae, Ye Rim Kim, Minsol Kim, Ji Eun Moon, Sangsoo Han Annals of the Academy of Medicine, Singapore.2023; 52(12): 660. CrossRef
Development and validation of a length- and habitus-based method of total body weight estimation in adults Mike Wells, Lara Nicole Goldstein, Giles Cattermole The American Journal of Emergency Medicine.2022; 53: 44. CrossRef
A validation of newly developed weight estimating tape for Korean pediatric patients Sungwoo Choi, Sangun Nah, Sumin Kim, Eun O. Seong, So Hyun Kim, Sangsoo Han, Tariq Jamal Siddiqi PLOS ONE.2022; 17(7): e0271109. CrossRef
Accuracy of Weight Estimation in Children Using the Broselow, PAWPER XL, PAWPER XL-MAC, and Mercy Tapes Rafiuk Cosmos Yakubu, Nedda Ayi-bisah, Samuel Blay Nguah Pediatric Emergency Care.2022; 38(9): e1517. CrossRef
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