A Multicenter Study for Validation of the New Pediatric Advanced Life Support Tape for Indian Children.

OBJECTIVE

Accurate weight estimation is essential for drug dosing and equipment selection in pediatric emergencies. A new Pediatric Advanced Life Support (ALS) tape was developed using Indian growth references. The present study was performed to validate its performance in critically ill children across multiple centers in India.

METHODS

A prospective, cross-sectional, multicenter observational study was conducted in 13 pediatric intensive care units (PICUs) across five zones of India in children aged < 12 years. Recumbent length was measured using the new ALS tape, and color-band-based estimated weight recorded. Weight was measured using a digital scale. The primary outcomes were bias, precision, and accuracy of the tape in predicting weight. Secondary outcomes included correlation between estimated and measured weight, agreement using Bland-Altman analysis, center-wise subgroup analyses, and interrater reliability for color-band assignment.

RESULTS

Out of 2740 children measured, 2253 were included in the final analysis. Correct color-band concordance was observed in 79.9% of children. Overall, 78.6% of estimates were within ± 10% and 84.6% within ± 15% of measured weight. The mean difference between estimated and measured weight was - 0.6 kg (0.08%). Lower color bands showed modest underestimation (13.1%), while higher bands showed mild overestimation (- 10.3%). Regional concordance ranged from 65.9% to 91.4%. Interrater reliability demonstrated strong agreement (κ = 0.84; 95% CI 0.61, 1.00).

CONCLUSIONS

The Indianized Pediatric ALS tape demonstrated acceptable accuracy, minimal overall bias, and strong interrater reliability in critically ill Indian children. Although some variability was observed across regions and lower weight bands, the new ALS tape represents a practical and reasonably accurate indigenous alternative for emergency weight estimation in diverse PICU settings across India.