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doi: https://doi.org/10.15441/ceem.23.110    [Accepted]
Is there evidence that length-based tapes with precalculated drug doses increase the accuracy of drug dose calculations in children? A systematic review
Mike Wells1,2 , Penelope Yende1
1Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
2Department of Emergency Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
Correspondence  Mike Wells Email: wellsm@health.fau.edu
Received: August 15, 2023. Revised: September 24, 2023.  Accepted: September 24, 2023. Published online: November 29, 2023.
ABSTRACT
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 determine how these tapes compare to 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.
Keywords: Weight estimation; Broselow tape; Drug dosing; Patient safety
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