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Development and Validation of a Length- and Habitus-Based Method of Ideal and Lean Body Weight Estimation for Adults Requiring Urgent Weight-Based Medical Intervention

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Abstract

Background and Objective

Accurate drug dosing in obese patients requires an estimation of ideal body weight (IBW) or lean body weight (LBW) for dosing hydrophilic medications. Erroneous weight estimates during the management of adults requiring weight-based treatment may contribute to poor outcomes. Existing methods of IBW and LBW estimation or measurement are very difficult to use during emergency care. A new point-of-care model would be useful to provide rapid estimates of IBW and LBW for this purpose.

Methods

A model was derived based on the PAWPER XL-MAC tape, a pediatric weight estimation system which uses recumbent length and mid-arm circumference to estimate IBW and LBW. The new adult model was used to generate IBW and LBW estimations for a derivation sample (n = 33155) and a validation sample (n = 5926) from National Health and Nutrition Examination Survey (NHANES) datasets. The model was developed in two steps, with calibration at each step, before being validated on an unused dataset. The outcome measure was to achieve >95% of IBW and LBW estimations within 20% of recognized reference standards (P20 > 95%) and >70% of estimations within 10% of these standards (P10 > 70%).

Results

The new model achieved a P20 of 100% and a P10 of 99.9% for IBW and a P20 of 98.3% and a P10 of 78.3% for LBW. This accuracy was maintained in both sexes, all ages, all ethnic groups, all lengths, and in all habitus types, except for the severely obese female subgroup.

Conclusions

The modified PAWPER XL-MAC model proved to be an accurate method of IBW and LBW estimation. It could, therefore, have an important role in facilitating emergency drug dose calculations in obese adult patients.

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Authors and Affiliations

  1. Department of Emergency Medicine, Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, FL, USA

    Mike Wells

  2. Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Lara Nicole Goldstein

  3. Emergency Department, Princess Royal University Hospital, King’s College Hospital NHS Trust, London, UK

    Giles Cattermole

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Corresponding author

Correspondence to Mike Wells.

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Funding

No source of funding was used for this study.

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MW, LNG and GC declare no conflict of interest.

Ethics Approval

All procedures in this study were in accordance with the 1964 Helsinki Declaration. The National Health and Nutrition Survey Examination studies were all approved by the Research Ethics Review Board of the National Center for Health Statistics. This study was exempt from any additional IRB review as the study only utilized anonymized publicly available data.

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Not applicable.

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The datasets are freely available on the CDC website.

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Each author contributed significantly to the concept development, methodology, analysis, and writing of this paper.

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Wells, M., Goldstein, L.N. & Cattermole, G. Development and Validation of a Length- and Habitus-Based Method of Ideal and Lean Body Weight Estimation for Adults Requiring Urgent Weight-Based Medical Intervention. Eur J Drug Metab Pharmacokinet 47, 841–853 (2022). https://doi.org/10.1007/s13318-022-00796-3

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