Accurate weight estimates are important because they are used to determine appropriate medication dosage, fluid volumes for resuscitation, breathing tube sizes, and more.
But what do you do in situations when you are unable to weigh the child?
The Mercy TAPE was developed by Children’s Mercy researchers led by Susan Abdel-Rahman, Pharm.D, Clinical Pharmacology and Medical Toxicology, (TAPE stands for TAking the guesswork out of Pediatric weight Estimation) to address that question.
The unique and pragramatic Mercy Tape has been demonstrated to be more accurate than any other method currently available for children ages two months to 16 years, accurately predicting weight within 10 percent of actual weight in about 80 percent of children, and within 20 percent of actual weight in 98 percent of children; in essence, getting within 20 percent of actual weight in nearly 100 percent of children (including children that are malnourished or obese)…all at a cost of about 1/3 of a penny per device.
Dr. Susan Abel-Rahman is here to explain how The Mercy TAPE allows clinicians to get an accurate idea of a child’s weight by making two measurements of the upper arm.
Selected Podcast
Mercy Tape: Taking the Guesswork Out of Pediatric Weight Estimation
Featured Speaker:
Learn more about Dr. Susan Abel-Rahman
Susan M. Abdel-Rahman, PharmD
Dr. Susan Abel-Rahman is the Section Chief of Personalized Therapeutics at Children’s Mercy Kansas City, where she Dr. Rahman directs the Fungal Genomics Laboratory and the Developmental Pharmacokinetic and Pharmacodynamic Core Laboratory. She received her BS in Pharmacy at Rutgers University, where she also received her Doctorate in Clinical Pharmacy. Dr. Rahman completed a fellowship in pediatrics at The Ohio State University.Learn more about Dr. Susan Abel-Rahman
Transcription:
Mercy Tape: Taking the Guesswork Out of Pediatric Weight Estimation
Dr. Michael Smith (Host): Our topic today is, "Mercy Tape: Taking the Guesswork out of Pediatric Weight Estimation". My guest is Dr. Susan Rahman. Dr. Rahman is the Section Chief of Personalized Therapeutics at Children’s Mercy Kansas City. Dr. Rahman, welcome to the show.
Dr. Susan Rahman (Guest): Thank you for having me.
Dr. Smith: I’m glad you’re here. Let’s first just talk about the importance of accurate weight in pediatrics. How important really is that in, say, dosing medication for children?
Dr. Rahman: Sure. Weight pretty much drives everything we do in the care of children. We use weight to identify the most accurate dose for children. Weight is used to identify the correct volume of resuscitation fluids for children. Weights are even used to calculate cardiac voltage for resuscitation of children. So, it really drives just about all the decisions we make when caring for children.
Dr. Smith: When you think of a general pediatric practice the old-fashioned way was just to get them on the scale as best you can. Is there a problem with that or are those scales not accurate? Do we need to move this technology up? What’s the issue there?
Dr. Rahman: No. The scales are the gold standard. They’re highly accurate and they’re really the first thing we do whenever we see a child. Weight is taken as part of a vital sign. The reason we developed Mercy Tape was for settings where a scale is not available. So, there are resource restricted settings where you don’t have access to a scale. There are emergency and trauma settings ,again, where you might not be able to weight the child in time to make the decisions that you need and there are some subsets of children that are wheelchair bound, that may have other mobility issues ,that cannot be weighed in a traditional way.
Dr. Smith: So, that's really it. So, Mercy Tape is really the solution to the problem of not having a scale in a very specific setting. So, let’s talk a little bit about Mercy Tape, then. How does the Mercy Tape really work and how does it become the solution to the problem?
Dr. Rahman: Sure. Mercy Tape works by looking at markers of growth and development. We look at markers of how tall you are or growth velocity by looking at the length of a long bone and we look at kind of how big you are by looking at how big you are by looking at the girth around a specific muscle segment. So, by applying kind of a mathematical algorithm to two of those measurements that we take just in one small area of the body, we are able to generate a strategy for estimating weight very quickly, really, with the addition of just two simple numbers.
Dr. Smith: I’m sure you’ve compared the Mercy Tape to a more standard scale. How does the mercy tape measure up, if you will--if I can--to the gold standard scale?
Dr. Rahman: Mercy Tape is actually highly accurate. So, we’re within 10% of the child’s actual weight in over 80% of children and within 20% of their actual weight in almost 100% of children. So, it’s really quite close. We’ve also evaluated it against other standards that are used and we are far more robust over a much broader population and a much more diverse population than the other methods that are being used that are out there.
Dr. Smith: How long has the Mercy Tape measure been around? When did this develop? Who was involved and, I guess, where do you see this being best used?
Dr. Rahman: The original development took place around 2010. It stemmed from work we were doing with the World Health Organization. We were involved with them trying to optimize dosing regimens for children with tuberculosis, HIV, malaria and that type of thing. One of the stakeholders at the meeting raised a very important point which is, it’s wonderful to have these accurate dosing guidelines for children but for those of us who don’t have the ability to weigh a child, what are we expected to do? So, it started by looking at the existing strategies that are out there and not having a weight on a child is really not an option. So, for individuals that didn’t have the capacity to weigh children, they were using surrogates based age or surrogates based on length and when you actually broke those down, they're not all highly accurate. They introduce a lot of error, they don’t cover the broad spectrum of age in children and they really fail at the extremes of age and the extremes of weight. So, in our malnourished children and our overweight/obese children, these methods were really performing poorly. We didn’t want to necessarily invent something new if there was something out there that existed but after looking at what was available, we realized that there was a need for a more accurate estimation measure. So, it was originally developed with resource restricted settings in mind. It’s hard for us, perhaps, in developed countries to appreciate just how critical or acute the need is but there are over 2 billion children in the world and about a billion of them are living in poverty. About 270 million of them don’t have access to basic healthcare services. So, this was really addressed to identify a need for that population but then to extend out to our medical partners in the emergency room and in trauma settings and in rehabilitation medicine, for example, where we’re using the Mercy Tape not only to estimate weight but also to estimate height, again, in children with mobility impairments.
Dr. Smith: Is Children’s Mercy, then, taking on a very proactive role in educating some of the community physicians on how to use this weight estimation even then going out to some of these underdeveloped countries? What role is the hospital taking in educating doctors on using this?
Dr. Rahman: We try to be incredibly responsible in the development and dissemination. So, this was developed with numerous studies. We did studies here in the U.S. to validate. We went overseas to West Africa, to India and to China to make sure that it was broadly applicable, understanding the cultural issues that we had to deal with. It was developed specifically with cultural issues in mind where we might not have an age of a child if they’re not maintaining birth records and we might not want to access other limbs in a Muslim country for children where we don’t want to lift their skirt. So, this was really done to make sure that we were sensitive to the needs of communities that required it. We created instructional materials that were completely non-verbal; that are all illustrated to show how to use the method. Now, there’s still the caveat that it requires some simple addition and we’ve got ways to get around that as well but we’ve tried to be incredibly proactive in creating our educational materials. There hasn’t been a lot of education in our local community because most of our children have access to clinics where there are scales. Whenever we are contacted from settings that require this technology, we work very closely with them to make sure they have the education materials they need and to make sure that we provide additional instruction as they deem is relevant for their population. We get requests for this device, I would say, about once every two weeks. We are mailing all over the world.
Dr. Smith: This is really awesome because here you are, really, leading the way for providing a solution to a significant problem when the gold standard scale is not available. As you mentioned, weight is key to taking care of these children and all kinds of different settings. This is really great and, Dr. Rahman, I want to thank you for the work that you’ve done with the Mercy Tape and thank you for coming on the show. You’re listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information, you can go to childrensmercy.org. That’s childrensmercy.org. I’m Dr. Michael Smith. Thanks for listening.
Mercy Tape: Taking the Guesswork Out of Pediatric Weight Estimation
Dr. Michael Smith (Host): Our topic today is, "Mercy Tape: Taking the Guesswork out of Pediatric Weight Estimation". My guest is Dr. Susan Rahman. Dr. Rahman is the Section Chief of Personalized Therapeutics at Children’s Mercy Kansas City. Dr. Rahman, welcome to the show.
Dr. Susan Rahman (Guest): Thank you for having me.
Dr. Smith: I’m glad you’re here. Let’s first just talk about the importance of accurate weight in pediatrics. How important really is that in, say, dosing medication for children?
Dr. Rahman: Sure. Weight pretty much drives everything we do in the care of children. We use weight to identify the most accurate dose for children. Weight is used to identify the correct volume of resuscitation fluids for children. Weights are even used to calculate cardiac voltage for resuscitation of children. So, it really drives just about all the decisions we make when caring for children.
Dr. Smith: When you think of a general pediatric practice the old-fashioned way was just to get them on the scale as best you can. Is there a problem with that or are those scales not accurate? Do we need to move this technology up? What’s the issue there?
Dr. Rahman: No. The scales are the gold standard. They’re highly accurate and they’re really the first thing we do whenever we see a child. Weight is taken as part of a vital sign. The reason we developed Mercy Tape was for settings where a scale is not available. So, there are resource restricted settings where you don’t have access to a scale. There are emergency and trauma settings ,again, where you might not be able to weight the child in time to make the decisions that you need and there are some subsets of children that are wheelchair bound, that may have other mobility issues ,that cannot be weighed in a traditional way.
Dr. Smith: So, that's really it. So, Mercy Tape is really the solution to the problem of not having a scale in a very specific setting. So, let’s talk a little bit about Mercy Tape, then. How does the Mercy Tape really work and how does it become the solution to the problem?
Dr. Rahman: Sure. Mercy Tape works by looking at markers of growth and development. We look at markers of how tall you are or growth velocity by looking at the length of a long bone and we look at kind of how big you are by looking at how big you are by looking at the girth around a specific muscle segment. So, by applying kind of a mathematical algorithm to two of those measurements that we take just in one small area of the body, we are able to generate a strategy for estimating weight very quickly, really, with the addition of just two simple numbers.
Dr. Smith: I’m sure you’ve compared the Mercy Tape to a more standard scale. How does the mercy tape measure up, if you will--if I can--to the gold standard scale?
Dr. Rahman: Mercy Tape is actually highly accurate. So, we’re within 10% of the child’s actual weight in over 80% of children and within 20% of their actual weight in almost 100% of children. So, it’s really quite close. We’ve also evaluated it against other standards that are used and we are far more robust over a much broader population and a much more diverse population than the other methods that are being used that are out there.
Dr. Smith: How long has the Mercy Tape measure been around? When did this develop? Who was involved and, I guess, where do you see this being best used?
Dr. Rahman: The original development took place around 2010. It stemmed from work we were doing with the World Health Organization. We were involved with them trying to optimize dosing regimens for children with tuberculosis, HIV, malaria and that type of thing. One of the stakeholders at the meeting raised a very important point which is, it’s wonderful to have these accurate dosing guidelines for children but for those of us who don’t have the ability to weigh a child, what are we expected to do? So, it started by looking at the existing strategies that are out there and not having a weight on a child is really not an option. So, for individuals that didn’t have the capacity to weigh children, they were using surrogates based age or surrogates based on length and when you actually broke those down, they're not all highly accurate. They introduce a lot of error, they don’t cover the broad spectrum of age in children and they really fail at the extremes of age and the extremes of weight. So, in our malnourished children and our overweight/obese children, these methods were really performing poorly. We didn’t want to necessarily invent something new if there was something out there that existed but after looking at what was available, we realized that there was a need for a more accurate estimation measure. So, it was originally developed with resource restricted settings in mind. It’s hard for us, perhaps, in developed countries to appreciate just how critical or acute the need is but there are over 2 billion children in the world and about a billion of them are living in poverty. About 270 million of them don’t have access to basic healthcare services. So, this was really addressed to identify a need for that population but then to extend out to our medical partners in the emergency room and in trauma settings and in rehabilitation medicine, for example, where we’re using the Mercy Tape not only to estimate weight but also to estimate height, again, in children with mobility impairments.
Dr. Smith: Is Children’s Mercy, then, taking on a very proactive role in educating some of the community physicians on how to use this weight estimation even then going out to some of these underdeveloped countries? What role is the hospital taking in educating doctors on using this?
Dr. Rahman: We try to be incredibly responsible in the development and dissemination. So, this was developed with numerous studies. We did studies here in the U.S. to validate. We went overseas to West Africa, to India and to China to make sure that it was broadly applicable, understanding the cultural issues that we had to deal with. It was developed specifically with cultural issues in mind where we might not have an age of a child if they’re not maintaining birth records and we might not want to access other limbs in a Muslim country for children where we don’t want to lift their skirt. So, this was really done to make sure that we were sensitive to the needs of communities that required it. We created instructional materials that were completely non-verbal; that are all illustrated to show how to use the method. Now, there’s still the caveat that it requires some simple addition and we’ve got ways to get around that as well but we’ve tried to be incredibly proactive in creating our educational materials. There hasn’t been a lot of education in our local community because most of our children have access to clinics where there are scales. Whenever we are contacted from settings that require this technology, we work very closely with them to make sure they have the education materials they need and to make sure that we provide additional instruction as they deem is relevant for their population. We get requests for this device, I would say, about once every two weeks. We are mailing all over the world.
Dr. Smith: This is really awesome because here you are, really, leading the way for providing a solution to a significant problem when the gold standard scale is not available. As you mentioned, weight is key to taking care of these children and all kinds of different settings. This is really great and, Dr. Rahman, I want to thank you for the work that you’ve done with the Mercy Tape and thank you for coming on the show. You’re listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information, you can go to childrensmercy.org. That’s childrensmercy.org. I’m Dr. Michael Smith. Thanks for listening.