The RAMA Ped Card: Does it work for actual weight estimation in child patients at the emergency department

doi:10.5847/wjem.j.1920-8642.2017.02.008

Abstract

Abstract:

BACKGROUND: In emergency conditions, the actual weight of infants and young children are essential for treatments. The RAMATHIBODI Pediatric Emergency Drug Card or RAMA Ped Card has also been developed to estimate actual weight of the subjects. This study aimed to validate the RAMA Ped Card in correctly identifying the actual weight of infants and young adults.

METHODS: This study was a prospective study. We enrolled all consecutive patients under 15 years of age who visited the emergency department (ED). All eligible patients' actual weight and height were measured at the screening point of the ED. The weight of each patient was also measured using the unlabeled RAMA Ped Card. The Cohen's kappa values and agreement percentages were calculated.

RESULTS: During the study period, there were 345 eligible patients. The RAMA Ped Card had a 61.16% agreement with the actual weight with a kappa of 0.54 (P<0.01), while the agreement with the actual height had a kappa of 0.90 and 91.59% agreement. Sub-group analysis found kappa scores with good range in two categories: in cases of accidents and in the infant group (kappa of 0.68 and 0.65, respectively).

CONCLUSION: The RAMA Ped Card had a fair correlation with the actual weight in child patients presenting at the ED. Weight estimation in infant patients and children who presented with accidents were more accurate.

Key words: Child, Weight estimation, Card, Kappa

Thavinee Trainarongsakul, Pitsucha Sanguanwit, Supawan Rojcharoenchai, Kittisak Sawanyawisuth, Yuwares Sittichanbuncha. The RAMA Ped Card: Does it work for actual weight estimation in child patients at the emergency department[J]. World Journal of Emergency Medicine, 2017, 8(2): 126-130.

Figures/Tables 5

Figure 1.

Table 1

Table 2

Table 3

Table 4

References 18

1	Luten RC, Wears RL, Broselow J, Zaritsky A, Barnett TM, Lee T, et al. Length-based endotracheal tube and emergency equipment in pediatrics. Ann Emerg Med. 1992; 21(8):900-4. pmid: 1497153
2	Luten RC, Broselow J. Rainbow care: the Broselow-Luten system. Implications for pediatric patient safety. Ambul Outreach. 1999: 14-6. pmid: 10346573
3	Deboer S, Seaver M, Broselow J. Color coding to reduce errors. Am J Nurs. 2005; 105(8):68-71. doi: 10.1097/00000446-200508000-00031 pmid: 16062063
4	Heyming T, Bosson N, Kurobe A, Kaji AH, Gausche-Hill M. Accuracy of paramedic Broselow tape use in the prehospital setting. Prehosp Emerg Care. 2012; 16(3):374-80. doi: 10.3109/10903127.2012.664247 pmid: 22443376
5	Avidan A, Levin PD, Weissman C, Gozal Y. Anesthesiologists' ability in calculating weight-based concentrations for pediatric drug infusions: an observational study. J Clin Anesth. 2014; 26(4):276-80. doi: 10.1016/j.jclinane.2013.11.021 pmid: 24856861
6	Rowe C, Koren T, Koren G. Errors by paediatric residents in calculating drug doses. Arch Dis Child. 1998; 79(1):56-8. pmid: 9771254
7	Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell FW. A rapid method for estimating weight and resuscitation drug dosages from length in the pediatric age group. Ann Emerg Med. 1988; 17(6):576-81. doi: 10.1016/s0196-0644(88)80396-2 pmid: 3377285
8	Kleinman ME, Chameides L, Schexnayder SM, Samson RA, Hazinski MF, Atkins DL, et al. Pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics. 2010 Nov; 126(5):e1361-99. doi: 10.1542/peds.2010-2972D pmid: 20956434
9	Nieman CT, Manacci CF, Super DM, Mancuso C, Fallon WF, Jr. Use of the Broselow tape may result in the underresuscitation of children. Acad Emerg Med. 2006; 13(10):1011-9. doi: 10.1197/j.aem.2006.06.042 pmid: 17015417
10	Mishra DG, Kole T, Nagpal R, Smith JP. A correlation analysis of Broselow™ Pediatric Emergency Tape-determined pediatric weight with actual pediatric weight in India. World J Emerg Med. 2016; 7(1):40-3. doi: 10.5847/wjem.j.1920-8642.2016.01.007 pmid: 27006737
11	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(4):121-5. pmid: 21955338
12	Sinha M, Lezine MW, Frechette A, Foster KN. Weighing the pediatric patient during trauma resuscitation and its concordance with estimated weight using Broselow Luten Emergency Tape. Pediatr Emerg Care. 2012; 28(6):544-7. doi: 10.1097/PEC.0b013e318258ac2e pmid: 22653453
13	House DR, Ngetich E, Vreeman RC, Rusyniak DE. Estimating the weight of children in Kenya: do the Broselow tape and age-based formulas measure up? Ann Emerg Med. 2013; 61(1):1-8. doi: 10.1016/j.annemergmed.2012.07.110 pmid: 22939608
14	Ken MW, Yasin A, Knight J, Noel D, Lubell R, Filler G. Ontario children have outgrown the Broselow tape. CJEM. 2012; 14(1):25-30. doi: 10.2310/8000.2011.110523 pmid: 22417954
15	Trakulsrichai S, Boonsri C, Chatchaipun P, Chunharas A. Accuracy of three methods used for Thai children's body weight estimation. J Med Assoc Thai. 2012; 95(9):1194-9. pmid: 23140037
16	Loo PY, Chong SL, Lek N, Bautista D, Ng KC. Evaluation of three paediatric weight estimation methods in Singapore. J Paediatr Child Health. 2013; 49(4):E311-6. doi: 10.1111/jpc.12141 pmid: 23489439
17	Young KD Korotzer NC. Weight estimation methods in children: a systematic review. Ann Emerg Med. 2016; 68(4):441-451.e10. doi: 10.1016/j.annemergmed.2016.02.043 pmid: 27105839
18	Wells M, Coovadia A, Kramer E, Goldstein L. The PAWPER tape: A new concept tape-based device that increases the accuracy of weight estimation in children through the inclusion of a modifier based on body habitus. Resuscitation. 2013; 84(2):227-32. pmid: 22796544

Band number	Color	Estimated actual weight (kg)
1	Blue	3-5
2	Green	6-7
3	Yellow	8-9
4	Light pink	10-11
5	Navy blue	12-14
6	Orange	15-18
7	Dark pink	19-22 (19-23.99)^*
8	Purple	24-28 (24-29.99)^*
9	Brown	30-36

Factors	Number (%)
Sex
Male	192 (55.65)
Female	153 (44.35)
Age group
Infant	66 (19.13)
Preschool	168 (48.70)
Primary school	111 (32.17)
Median actual weight, kg (min, max)	14.10 (3.30, 49.60)
Mean actual height, cm (SD)	97.01 (24.14)
Underlying disease
Yes	144 (41.74)
No	201 (58.26)
Current medication
Yes	118 (34.20)
No	227 (65.80)
Presenting disease
Accidents	36 (10.43)
Non-accident	309 (89.57)
Level of emergency
Emergent	2 (0.58)
Urgent	174 (50.43)
Non-urgent	169 (48.99)
Treatment at the ED
Yes
Bronchodilator	37 (10.73)
IV fluid	33 (9.56)
IV/oral medications	258 (74.78)
No	17 (4.93)
Discharge status
Admitted	67 (19.42)
Discharged	266 (77.10)
Referred	12 (3.48)

Outcomes	Number (%)
Concordance with actual weight	211 (61.16)
Under the actual weight	70 (20.29)
Over the actual weight	64 (18.55)
Concordance with actual weight ± one band error	335 (97.10)

Features	% agreement	Kappa values	P values
Level of emergency
Emergent	59.09	0.53	<0.01
Non-emergent	59.17	0.53	<0.01
Disease type
Accidents	72.22	0.68	<0.01
Non-accident	57.61	0.52	<0.01
Age groups
Infants	75.76	0.65	<0.01
Pre-school age	54.76	0.40	<0.01
School age	55.86	0.42	<0.01

[1]	Young Min Kim, Hyun Seok Chai, Gwan Jin Park, Sang Chul Kim, Hoon Kim, Seok Woo Lee, Hyeon Jeong Park, Han Bit Kim, Hyo Been Lee, Ji Han Lee. Effect of bag valve ventilation versus mechanical ventilation after endotracheal intubation during cardiopulmonary resuscitation on outcomes following out-of-hospital cardiac arrest: a propensity score analysis [J]. World Journal of Emergency Medicine, 2025, 16(4): 313-320.
[2]	Rui Shao, Chenchen Hang, Xingsheng Wang, Luying Zhang, Fei Shao, Ziren Tang. The “SOOTEST-ICU” bundle for optimizing cerebral hypoxia and reperfusion to minimize brain injury after resuscitation from cardiac arrest [J]. World Journal of Emergency Medicine, 2025, 16(3): 206-211.
[3]	Jie Chen, Zhonghao Li, Xiaoyu Liu, Tianpeng Hu, Nan Gao, Weijian Zhang, Guoqiang Zhang. Potential common key genes associated with myocardial dysfunction and brain injury following cardiac arrest resuscitation in a rat model [J]. World Journal of Emergency Medicine, 2025, 16(3): 231-238.
[4]	Tingting Xu, Shaokun Wang, Liqiang Zhao, Jiawen Wang, Jihong Xing. A two-sample Mendelian randomization study on the relationship of body weight, body mass index, and waist circumference with cardiac arrest [J]. World Journal of Emergency Medicine, 2025, 16(2): 129-135.
[5]	Wachira Wongtanasarasin, Daniel K. Nishijima, Wanrudee Isaranuwatchai, Jeffrey S. Hoch. Real-world cost-effectiveness of targeted temperature management in out-of-hospital cardiac arrest survivors: results from an academic medical center [J]. World Journal of Emergency Medicine, 2025, 16(1): 28-34.
[6]	Hock Peng Koh, Jivanraj R. Nagarajah, Hasnita Hassan, Noel Thomas Ross. Bleeding characteristics and mortality outcomes following ST-elevation myocardial infarction thrombolysis: a 5-year analysis in an Asian population [J]. World Journal of Emergency Medicine, 2024, 15(6): 433-440.
[7]	Yedalm Yoo, Shin Ahn, Bora Chae, Won Young Kim. Performance of the EDACS-ADP incorporating high-sensitivity troponin assay: Do components of major adverse cardiac events matter? [J]. World Journal of Emergency Medicine, 2024, 15(3): 175-180.
[8]	Subi Abudurexiti, Shihai Xu, Zhangping Sun, Yi Jiang, Ping Gong. Glucose metabolic reprogramming-related parameters for the prediction of 28-day neurological prognosis and all-cause mortality in patients after cardiac arrest: a prospective single-center observational study [J]. World Journal of Emergency Medicine, 2024, 15(3): 197-203.
[9]	Jing Yang, Hanqi Tang, Shihuan Shao, Feng Xu, Yangyang Fu, Shengyong Xu, Chen Li, Yan Li, Yang Liu, Joseph Harold Walline, Huadong Zhu, Yuguo Chen, Xuezhong Yu, Jun Xu. A novel predictor of unsustained return of spontaneous circulation in cardiac arrest patients through a combination of capnography and pulse oximetry: a multicenter observational study [J]. World Journal of Emergency Medicine, 2024, 15(1): 16-22.
[10]	Rashed Alremeithi, Quincy K. Tran, Megan T. Quintana, Soroush Shahamatdar, Ali Pourmand. Approach to traumatic cardiac arrest in the emergency department: a narrative literature review for emergency providers [J]. World Journal of Emergency Medicine, 2024, 15(1): 3-9.
[11]	Shuang Xu, Lang Guo, Weijing Shao, Licai Liang, Tingting Shu, Yuhan Zhang, He Huang, Guangqi Guo, Qing Zhang, Peng Sun. Vagus nerve stimulation protects against cerebral injury after cardiopulmonary resuscitation by inhibiting inflammation through the TLR4/NF-κB and α7nAChR/JAK2 signaling pathways [J]. World Journal of Emergency Medicine, 2023, 14(6): 462-470.
[12]	Yufang Lin, Fei’er Song, Weiyue Zeng, Yichi Han, Xiujuan Chen, Xuanhui Chen, Yu Ouyang, Xueke Zhou, Guoxiang Zou, Ruirui Wang, Huixian Li, Xin Li. Cardiopulmonary prognosis of prophylactic endotracheal intubation in patients with upper gastrointestinal bleeding undergoing endoscopy [J]. World Journal of Emergency Medicine, 2023, 14(5): 372-379.
[13]	Gannan Wang, Zhe Wang, Yi Zhu, Zhongman Zhang, Wei Li, Xufeng Chen, Yong Mei. The neuro-prognostic value of the ion shift index in cardiac arrest patients following extracorporeal cardiopulmonary resuscitation [J]. World Journal of Emergency Medicine, 2023, 14(5): 354-359.
[14]	Qiang Zhou, Xuejie Dong, Wei Zhang, Rengyu Wu, Kaizhu Chen, Hongjuan Zhang, Zhijie Zheng, Lin Zhang. Effect of a low-cost instruction card for automated external defibrillator operation in lay rescuers: a randomized simulation study [J]. World Journal of Emergency Medicine, 2023, 14(4): 265-272.
[15]	Guang-qi Guo, Yan-nan Ma, Shuang Xu, Hong-rong Zhang, Peng Sun. Effect of post-rewarming fever after targeted temperature management in cardiac arrest patients: a systematic review and meta-analysis [J]. World Journal of Emergency Medicine, 2023, 14(3): 217-223.