Use of the Broselow tape may result in the underresuscitation of children

The purpose of this study was to determine the concordance of the Broselow tape with the measured heights and weights of a community-based population of children, especially in light of the increase in obesity in today's children. The authors examined more than 7,500 children in a cross-sectional, descriptive study in two different cohorts of children to compare their actual weight with their predicted weight by a color-coded tape measure. In all patients, the percent agreement and kappa values of the Broselow color predicted by height versus the actual color by weight for the 2002A tape were 66.2% and 0.61, respectively. The concordance was best in infants, followed by school-age children, toddlers, and preschoolers (kappa = 0.66, 0.44, 0.39, and 0.39, respectively; percent agreement, 81.3%, 58.2%, 60.7%, and 64.0%, respectively). The tapes accurately predicted (within 10%) medication dosages for resuscitation in 55.3%-60.0% of the children. The number of children who were underdosed (by > or =10%) exceeded those who were overdosed (by > or =10%) by 2.5 to 4.4 times (p < 0.05). The tapes accurately predicted uncuffed endotracheal tube sizes when compared with age-based guidelines in 71% of the children, with undersizing (> or =0.5 mm) exceeding oversizing by threefold to fourfold (p < 0.05). The Broselow tape color-coded system inaccurately predicted actual weight in one third of children. Caregivers need to take into consideration the accuracy of this device when estimating children's weight during the resuscitation of a child.