Multicentre validation of paediatric weight estimation methods in Indonesian children: a comparison of length-based, habitus-adjusted and age-based approaches.

BACKGROUND: Accurate weight estimation in paediatric emergencies is essential for determining appropriate drug dosage and equipment sizes. In Indonesia, where emergency tapes are not widely available, the 2011 Advanced Paediatric Life Support (APLS) formula is commonly used although its accuracy in the local population remains uncertain. This study aimed to evaluate and compare the accuracy of four weight estimation methods-the 2019 Broselow Tape, the 2022 Dose-by-Growth (DbG) Tape, the 2009 Paediatric Advanced Weight Prediction in the Emergency Room (PAWPER) Tape and the 2011 APLS formula. METHODS: This multicentre cross-sectional study included 1448 Indonesian children aged 0-12 years from two major hospitals. Estimated weights using the four methods were compared with actual body weight. Agreement was assessed using Bland-Altman plots, while accuracy was evaluated using the percentage of weight estimates within 10% and 20% of actual weight (PW10 and PW20). RESULTS: The PAWPER Tape demonstrated the highest accuracy (PW20=89.4%) with low bias (mean percentage error (MPE) 4.6±12.8%). The Broselow Tape (MPE 5.1±15.9%; PW20=82.7%) and DbG Tape (MPE 7.3±16.0%; PW20=79.6%) showed comparable performance. In contrast, the APLS formula had substantially greater bias and lower accuracy (MPE 14.0±28.5%; PW20=58.8%) and demonstrated consistent overestimation across most weight categories. CONCLUSION: PAWPER Tape showed the best accuracy and agreement with measured weight in Indonesian children followed by the Broselow and DbG Tapes. In contrast, the 2011 APLS formula performed poorly, with greater error and systematic overestimation. These findings support the use of length-based and habitus-adjusted methods in paediatric emergency settings.