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UF doctor co-created lifesaving children’s dosing system

Published: November 13, 2013 By: Tiffany Wilson
Robert Luten, MD, holds the pediatric tape he co-created. Next to him is a cart with color-coded drawers that contain the appropriate equipment for the corresponding color zones on the tape. Robert Luten, MD, holds the pediatric tape he co-created. Next to him is a cart with color-coded drawers that contain the appropriate equipment for the corresponding color zones on the tape.

Imagine having to guess a seriously injured child’s weight in a matter of seconds and then perform a series of math formulas in order to give the child the right dose of medicine.

Move one decimal point in the wrong direction, take too long with your math or guess the wrong weight and there’s a strong chance the child will die.

Robert Luten, MD, has one word for that scenario: disaster.

Unfortunately, the University of Florida College of Medicine – Jacksonville pediatric emergency medicine professor remembers facing that kind of pressure many times early in his career. The math problems were easy to botch in the chaos of a medical emergency. In addition, since children require such small amounts of medicine, a correct dose and a dose 10 times too high could fit in the same syringe, making it difficult to spot an error. And most children were taken to emergency rooms where doctors rarely treated children, so they were less comfortable and less familiar with the very different medical needs of a child. It was a system set up for failure, and it failed many times. Good doctors, nurses and paramedics made terrible mistakes in the rush to save a child’s life.

In the mid-1980s, Luten decided to do something about it.

He came up with a chart that bypassed a lot of the math, showing the dosage amounts for children and emergency equipment based on age and weight. He wrote his first-ever paper about it. The only problem: doctors would still have to guess a child’s weight and they were wrong as often as they were right.

Then another physician, James Broselow, MD, presented his own idea to the American Academy of Pediatrics Pediatric Advanced Life Support (PALS) committee: a “measuring” tape system. The Broselow Tape, as it would later be known, could be placed next to a child to determine height. Each height range was assigned to a color zone that showed the average weight for that height, eliminating the need to guess.

Luten, who was a member of the committee, thought the idea was ingenious. He wrote Broselow a letter saying so. The doctors decided to work as a team, and nearly three decades later, the Broselow-Luten System has saved children’s lives all over the world.

The color-coded tape, which has gone through several modifications over the years, can be found in most emergency rooms and aboard most ambulances. Besides displaying a child’s estimated weight, the tape includes charts listing key medicine dosage amounts and equipment sizes required for a child in each category. Accompanying the tape, emergency personnel use medicine and equipment in color-coded packages that coordinate with the colors on the tape. So, for example, if a child is having trouble breathing, the system instantly indicates which of 10 different tracheal tube sizes is correct for him or her.

The tape was just the beginning of Broselow and Luten’s ongoing quest to improve pediatric emergency medicine. They later created the Artemis system, a software suite that can be used not only to determine what medicine or equipment a child needs, but also to order and track what is used. It serves as a thorough guide for treatment in a vast spectrum of emergency situations, including seizures, diabetic shock, severe burns, even exposure to chemical weapons. Hundreds of hospitals – including UF Health Jacksonville – use Artemis, which is compatible with computers, iPads and mobile devices.

The mobile application version of Artemis, called SafeDose, can be used anywhere to determine the standard dose for a patient. It also includes instructions on how to prepare and administer the treatment, serving as an immediately accessible guide for nurses and pharmacists preparing and administering lifesaving medications under stress. Medication errors in that type of setting have been shown to be as high as 25 percent. But Luten said studies have demonstrated the errors are virtually eliminated with Artemis.

There is one factor that has had an increasing impact on the system: childhood obesity. Children who are severely overweight do not always fall within the correct weight zone for their height. Luten said the tape system used to accurately predict a child’s weight 80 percent of the time. With an epidemic of heavier children in America, however, its accuracy has dropped to 65 percent.

The good news? Luten said not all medicines should be administered based on actual weight. Many are dosed based on ideal weight, which will not change regardless of obesity. The size of equipment needed for the child will also remain the same because length, not weight, best predicts equipment sizes.

“It doesn’t make any difference,” Luten said. “Your trachea is the same size regardless of weight.”

If a more exact weight is needed, though, there is an easy answer. Luten said 99 percent of children fall within one weight range that is one zone above or below the average for their height on the Broselow Tape. In a situation when there is no time or no way to weigh a child, emergency personnel can visually surmise whether the child is overweight. Adjusting or “bumping” up one color zone above the child’s estimated weight zone will more closely approximate the child’s actual weight. Likewise, they would bump down one zone for a child who was markedly underweight.

While they might not have known just how prevalent their system would become, Luten said he and Broselow knew the tape would have an impact on pediatric medicine.

“When we created it, we both knew it was the simplest possible solution to one of the most difficult problems people had,” he said. “Whenever we showed it to someone, they didn’t want to give it back.”

Now that the tape is available to medical personnel all over the world, Luten said he expects it to be the standard for a very long time.

“Ultimately, it will continue to be around because it’s so easy to use,” he said.

For more information about the Broselow-Luten System and the Artemis Dosing System, go to ebroselow.com.

Robert Luten, MD, holds the pediatric tape he co-created. Next to him is a cart with color-coded drawers that contain the appropriate equipment for the corresponding color zones on the tape.

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