The Broselow Scale is a length-based tape measure used by healthcare professionals during pediatric emergencies. It provides a rapid estimation of a child’s weight to determine correct medication dosages and equipment sizes. Developed in the mid-1980s by Dr. James Broselow and Dr. Robert Luten, the system was designed to reduce the cognitive burden on medical staff in high-stress situations.
How the Broselow Scale Works
To use the Broselow Scale, a medical provider places the child in a lying position. The tape has a red end marked with an arrow, which is aligned with the top of the child’s head. This orientation is remembered by the mnemonic “red to head,” ensuring the tape is used correctly.
With the red end held in place, the tape is smoothed down the length of the child’s body until it is even with their heels, not the tips of their toes. The measurement is taken at the point where the child’s heels land on the tape. This spot indicates an estimated weight and places the child into a specific color zone, which corresponds to pre-calculated emergency information.
This process provides a quick, standardized method for gathering data without a traditional scale, which is impractical in an emergency. The system is designed for children up to about 12 years of age or a maximum weight of around 36 kg (79 lbs). The measurement can be completed in seconds.
The Color-Coded System
Each color zone on the Broselow Tape corresponds to a specific estimated weight range. For example, the gray zone is for children weighing 3-5 kg, pink for 6-7 kg, and purple for 10-11 kg, with the colors progressing up to green for children weighing 30-36 kg. This color assignment unlocks pre-calculated medical information, reducing the chance of calculation errors during a chaotic event.
Once a color is determined, it provides immediate access to data, removing the need for manual calculations under pressure. This includes:
- Precise doses for emergency medications like epinephrine and atropine
- The correct size for endotracheal (breathing) tubes
- Appropriate energy settings for defibrillation
- Guidance on selecting other equipment, such as intravenous (IV) and suction catheters
To further streamline the process, many hospitals and emergency services organize their pediatric resuscitation supplies into color-coded carts or bags, called “Broselow Carts.” When a child is identified as being in the “yellow” zone, for instance, the medical team can go directly to the yellow drawer, which contains all the appropriately sized equipment and pre-calculated drug charts for a child of that weight range.
Importance in Emergency Situations
Calculating medication dosages based on a child’s weight is a complex task that can be slow and prone to dangerous errors, especially tenfold mathematical mistakes. The Broselow Scale was created to directly address this challenge by offloading the cognitive burden from medical providers during the critical first minutes of a resuscitation.
By providing pre-calculated doses and equipment sizes, the tape helps to minimize the risk of medication errors, which can have severe consequences in children. Studies have shown that without such aids, dosing errors can be common. The system acts as a safety net.
The visual nature of the color-coded system allows the medical team to work more efficiently. It creates a standardized approach, ensuring every member of the team is on the same page regarding equipment and dosages. This systematic process helps facilitate a safer resuscitation for pediatric patients.
Limitations and Evolving Practices
The primary limitation of the Broselow Scale is its reliance on length to estimate weight. The tape is based on the 50th percentile for weight at a given length, which estimates an ideal body weight. This can lead to inaccuracies for children who are significantly overweight or underweight for their height, a concern with rising rates of childhood obesity.
Research has shown that for some populations, the tape’s accuracy decreases as children get older and heavier. In some studies, the tape failed to predict weight accurately in over half of the pediatric trauma patients reviewed, often underestimating medication doses. For children who are “too tall for the tape,” another method of weight estimation must be used.
In response to these limitations, medical practices are evolving. Digital applications and electronic health records now provide more precise weight-based calculations, used to supplement or verify an initial Broselow estimate. Other systems, like the PAWPER tape, have been developed to incorporate a visual assessment of body habitus to adjust the weight estimate. These newer tools are used alongside the Broselow Scale to enhance accuracy.