A. W. Harrington1, N. Mehta1 1Boston Children’s Hospital,Boston, MA, USA
Introduction: While the success of feeding strategies in critically ill children requires routine surveillance of weight, growth curves represent just a fraction of the utility of an accurate weight for a pediatric patient. In addition to management of nutrition, weight guides medication dosing, ventilation management, and is used in emergency situations to determine voltage for electric shock or appropriate sizes of life-saving equipment.
Despite the importance of this single measurement, we, health care providers for critically ill children, are surprisingly poor at identifying an accurate initial weight. We are also poor at obtaining frequent weights and translating daily or weekly weights into what is termed the “weight for calculation” (WFC). This is the weight chosen by physicians to determine caloric needs, lung volumes, and perhaps most importantly, medication dosing. Medication dosing is typically an automated function of the electronic medical record based on the value entered for the WFC.
While some small studies have acknowledged the need for improvement in accuracy of anthropometric measurements of critically ill children, there is currently no standard for how frequently to obtain weights, nor evidence to support how frequently to update patients’ WFC. Not updating WFC with appropriate frequency can lead to inaccurate weight being used to guide prescriptions, nutrition and mechanical ventilation, which in turn can lead to medication errors, poor growth, or barotrauma.
Methods: The aim of our study is to describe current practices for obtaining and updating the WFC for patients admitted to the Boston Children’s Hospital (BCH) Medical-Surgical Intensive Care Unit (MSICU). This is a retrospective study of patients admitted to the BCH MSICU between 2010 and 2018. Patients admitted for less than 7 days or those who required extra-corporeal membrane oxygenation therapy were excluded. We gathered information on how patients’ initial weight was determined, how that weight was then translated into the initial WFC, how frequently the WFC was then updated over the course of a patient’s admission, how often the WFC differed from a patient’s weight, and by what magnitude.
Results: We found significant variability in the methods used to define the initial weight and frequent discrepancy between a patient’s current weight and WFC.
Conclusion: There is potential for improved outcomes with better understanding of how routinely we should be obtaining weights and updating patients’ WFC. Future studies may evaluate whether frequent weights and standardization for updating WFC is associated with improved growth, reduced ventilator days, or reduced intensive care unit length of stay.