• Mike Wells, Lara Nicole Goldstein, and Alison Bentley.
• Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa.
• J Emerg Med. 2018 Feb 1; 54 (2): 165-175.

BackgroundThe original methodology of the PAWPER (Pediatric Advanced Weight Prediction in the Emergency Room) tape relies on a gestalt visual assessment of a child's body habitus to adjust a length-based weight estimation. This assessment is dependent on the user's subjective opinion, which may result in aberrations in accuracy between users and populations. With the development of the second-generation PAWPER XL tape, a more objective method of habitus evaluation was desired.ObjectiveThe aim of this study was to evaluate a new, more objective figural reference image system and a new checklist system for quantifying body habitus.MethodsVolunteers were asked to assess the body habitus score of 90 children from a sequence of photographic images using the standard gestalt visual assessment system, a new checklist system, and a system using figural reference images. PAWPER XL tape weight estimations were generated from these scores, which were compared between the three test groups. Participants were also surveyed on their preferences for the different methodologies.ResultsThere were 11,505 habitus score assessments from 138 doctor, nurse, and paramedic participants. The figural reference image system significantly outperformed the checklist system and the gestalt visual assessment system in terms of weight estimation accuracy, achieving 70.9%, 61.1%, and 60.9% of estimations within 10% of measured weight, respectively. The participants expressed a strong subjective preference for the image system because of speed of use, ease of use, perceived accuracy, objectivity, and low cognitive load.ConclusionsThe figural reference image system was objectively much more accurate than, and subjectively preferable to, the original gestalt visual estimation methodology.Copyright © 2017 Elsevier Inc. All rights reserved.

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