A comparison of age-banded and weight-based oral paracetamol dosing in hospitalized children

Published Date: 03rd November 2022

Publication Authors: Wright K

Introduction
The British National Formulary for Children contains two dosing strategies for oral paracetamol; age-banded dosing for pain and pyrexia or weight-based dosing for post-operative pain. Only weight-based is used in our hospital. The aim of this study was to compare these dosing strategies using weights from a pediatric inpatient population.

Method
A single-centre retrospective analysis of 4 years data (to 23.03.2020) was undertaken in a tertiary pediatric hospital. Data collected from the electronic patient record included age, height, weight and gender. These measurements were linked to information on admission and procedure and to drug prescription records. Patients 3 months to 18 years were included. Automated data cleaning was performed. Multiple measurements were allowed for individual patients, but only one measurement per admission or procedure. The hospital patient data were compared to the Health Survey England (HSE) and National Child Measurement Programme (NCMP).

Results
Of 181,835 admissions it was possible to match weight to 115,466 (in 58,360 patients) and height to 18,822 (4906 patients). 95,787 paracetamol prescriptions were identified. Doses <10 mg/kg occurred in 5461 (5.7%) prescriptions and doses >20 mg/kg in 691 (0.72%) prescriptions. Of the doses <10 mg/kg, 1003 were in patients with a weight > 66.7 kg. In contrast, applying age-banded doses for this population would result in doses <10 mg/kg in 20,748 (18%) admissions (13,111 patients) and doses >20 mg/kg would occur in 4420 (3.8%) admissions (2054 patients), most commonly in teenagers. Weight-based dosing, with a maximum dose of 1 g, would lead to doses less than 10 mg/kg in 931 (0.8%) admissions (395 patients).

Discussion and Conclusion
The potential for inadequate or excessive paracetamol dosing is greater with age-banded doses compared with weight-based doses in hospitalized children. Compared to NCMP and HSE data, obesity (defined as a BMI >95th centile) is more common in hospitalized children across all age ranges. Compared to NCMP data, underweight (BMI <2nd centile) is more common in reception aged hospitalized children but not in year 6. Therefore, atypical body weights are more common in hospitalized children than the general population. A higher proportion of low body weight is seen in young children and teenagers. As a result, age-banded dosing should not be used in hospitalized children. Our findings, using opportunistic retrospective data retrieval, are in broad agreement with data from prospective observation studies (PEACHY). These methods of data collection are complementary; the larger retrospective dataset allows more complex subgroup analysis whilst prospective data provides validation and collection of specific data points.

 

Wright, K et al. (2022). A comparison of age-banded and weight-based oral paracetamol dosing in hospitalized children. Pediatric Anesthesia. epub 3 Nov(.), p... [Online]. Available at: https://doi.org/10.1111/pan.14595 [Accessed 10 January 2023]

 

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