How do I use the Broselow tape to estimate a child's weight in an emergency situation?

Using the Broselow Tape for Pediatric Weight Estimation in Emergencies

The Broselow tape is a length-based resuscitation tool that provides rapid weight estimation and precalculated medication doses by measuring a child's length from head to heel, with the child positioned supine on a flat surface.

Proper Measurement Technique

Position the child supine with the head against the red end of the tape at the headboard, extend the tape along the body's length, and read the color zone at the child's heels to obtain the estimated weight and corresponding medication doses. 1

• The tape should be placed on a flat surface with the child lying straight, ensuring the head contacts the headboard end of the tape 1
• Gently straighten the child's legs while measuring, ensuring toes point upward and knees are pressed down 1
• Read the color-coded zone that corresponds to the child's heel position, which provides both weight estimate and precalculated drug doses 2
• The tape eliminates the need for weight calculation and memorization during high-stress resuscitation scenarios 1, 2

Clinical Applications and Accuracy

The Broselow tape is most accurate for children weighing between 3.5 to 25 kg, with 79% of measurements falling within 15% error of actual weight, but accuracy significantly decreases in children over 25 kg or those taller than 144 cm. 2, 3

• For children 3.5-10 kg and 10-25 kg, the tape demonstrates excellent accuracy with regression slopes of 0.98 and 0.96 respectively (ideal = 1.00) 2
• The tape provides precalculated medication doses in milligrams for each color zone, simplifying physician ordering during emergencies 1
• Paramedics can accurately use the Broselow tape in prehospital settings, with correlation coefficients of 0.92 compared to scale weight and 0.97 compared to ED measurements 4
• The tape is appropriate for children 46-144 cm tall; beyond this range, alternative weight estimation methods must be used 3

Critical Limitations and Pitfalls

Do not use the Broselow tape for children over 10 years old or those taller than 144 cm, as 40% of 10-year-olds and 70% of 11-year-olds exceed the tape's range and cannot be assumed to have adult weight. 3

• Children too tall for the tape have a median weight of 41.9 kg, significantly less than the 55 kg median for 18-year-olds, meaning adult dosing would overestimate by approximately 30% 3
• Accuracy decreases substantially in obese children, with 80.8% of obese children having underestimated weights compared to only 13.6% of normal BMI children 5
• The tape underestimates weight in 29.4% of children overall, though most discrepancies involve only one color zone 5
• In populations with high rates of undernutrition, accuracy decreases as weight increases, particularly above 18 kg 6

Equipment Selection Using the Tape

The color-coded zones on the Broselow tape provide precalculated endotracheal tube sizes and equipment selections, though accuracy for tube sizing decreases in children weighing more than 18 kg. 6, 1

• Each color zone corresponds to specific equipment sizes including endotracheal tubes, laryngoscope blades, and chest tubes 1
• For children over 18 kg, use PALS age-based formulas for endotracheal tube size rather than relying solely on the Broselow tape 6
• The tape provides precalculated adrenaline doses that correlate well with PALS formulas in children under 18 kg (p = 0.08) 6

Medication Dosing Considerations

While the Broselow tape provides precalculated doses in milligrams, nurses must still convert these to milliliters for administration, representing a potential error point that requires additional calculation. 1

• The tape does not provide precalculated volumes in milliliters, requiring healthcare providers to perform concentration-based conversions 1
• For children weighing less than 40 kg, use pediatric weight-based dosing calculations (mg/kg) rather than adult fixed doses, regardless of age 7
• Weight-based dosing should use actual body weight for non-obese patients, but ideal body weight for obese patients to avoid over-resuscitation 8
• Subsequent doses should be titrated based on clinical response rather than continuing rigid weight-based calculations 8

Alternative Methods When Tape is Inappropriate

For children too tall for the Broselow tape, use mid-arm circumference (MAC) as the strongest correlate with weight, or apply the APLS formula for weight estimation. 3, 6

• MAC correlates most strongly with weight in children exceeding the tape's height range 3
• The Mercy TAPE, which uses mid-upper arm circumference and humeral length, provides improved accuracy in diverse populations 1
• For children over 40 kg, transition to adult dosing protocols 7
• Never assume children too tall for the tape are of adult weight without verification 3