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Smartphone use for Paediatric Calculations in Emergencies (SPaCE)
  1. Jordan Evans1,
  2. Zoe Morrison2,
  3. Rhian Thomas-Turner2,
  4. Omar Bouamra3,
  5. Stephen Mullen4,
  6. Jeff Morgan1
  1. 1 Paediatric Emergency Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
  2. 2 Children and Young Adults Research Unit, Noah's Ark Children's Hospital for Wales, Cardiff and Vale University Health Board, Cardiff, UK
  3. 3 University of Manchester, Manchester, UK
  4. 4 Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
  1. Correspondence to Dr Jordan Evans, Paediatric Emergency Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, CF14 4XW, UK; jordan.evans{at}


Background The preparation for critically ill children involves calculating drug and fluid volumes using the commonly taught WETFLAG (weight, energy, endotracheal tube, fluids, lorazepam, adrenaline, glucose) acronym. While smartphone applications (apps) are increasingly used for these calculations in clinical practice, limited studies have explored their accuracy and safety.

Aim To assess the accuracy of three calculation methods for paediatric emergency drug doses and fluid volumes: a smartphone app, reference charts and traditional calculation methods. The secondary aims were to investigate the effect on the time taken and self-reported stress levels.

Methods A convenience sample of healthcare professionals from four hospitals contributed. Participants calculated drug and fluid doses for fictional patients using the three different methods. The method and case order were randomised centrally. The study recorded the number of errors made during the calculations, healthcare professionals’ self-reported stress levels on a scale of 0 (no stress) to 10 (maximum stress) and the time taken for each case. The app was developed at the direct request of the study team.

Results Ninety-six participants calculated values for six fictional cases, resulting in 576 calculations. Traditional calculation methods showed a statistically significant higher rate of error compared with the use of a smartphone app or reference charts (mean=1, 0, 0, respectively). The smartphone app outperformed both traditional calculation methods and reference charts for time taken and user-reported stress levels.

Conclusions Traditional methods of ‘WETFLAG’ drug and fluid calculations are associated with a statistically significant increased risk of error compared with the use of reference charts or smartphone app. The smartphone app proved significantly faster and less stressful to use compared with traditional calculation methods or reference charts.

  • Paediatric Emergency Medicine
  • Emergency Care
  • Resuscitation
  • Technology

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Data are available upon reasonable request. Source data available upon reasonable request.

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  • Twitter @jordan_evans98, @Rhian_Thomas1, @drs_mullen

  • Contributors JE conceptualised the study, authored the initial manuscript and is the guarantor. OB performed the statistical analysis. All listed authors contributed substantially to study design, analysis and interpretation of data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests The smartphone application was developed by Project Medicine at the request of the authors. This was facilitated through a personal friendship between JE and Dr Miles Payling (CEO of Project Medicine). No financial exchange was involved. The authors have no financial, legal or any other ongoing connection with Project Medicine. Statistical analysis was undertaken for a fee by OB as a freelance medical statistician.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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