By: Sumeet Banker, MD, MPH
In the world of pediatrics, there are few things as important (and time-consuming) as dose calculations.
Many factors make pediatric prescribing a difficult task for pediatricians and occasional pediatric providers (family practitioners, emergency physicians, anesthesiologists) alike, and one seemingly small error could result in a dangerous overdose.
Questions for consideration include:
- What is the child’s weight?
- How old is the child?
- Can he reliably swallow a capsule?
- What strength is the liquid formulation?
A number of pediatric formulary/dose calculators have entered the mobile market to help providers navigate the complex waters of prescribing for children. Though each app has areas for improvement, Peds Meds brings considerable functionality to the often dysfunctional process of weight-based dosing in the busy clinic or emergency room situation.
Peds Meds is a simple, yet elegant dosage calculator with a searchable and customizable drug listing.The first screen that appears is the weight entry screen, where a patient’s weight may be entered in kilograms or pounds. Alternatively, the app uses 2008 CDC growth charts to estimate weight based on the child’s age if weight is unknown. Age may be entered in days, weeks, months, or years, and weight for the corresponding 50th percentile will be used for all calculations.
Once weight is entered or estimated, all medication doses are automatically calculated. The initial formulary contains approximately 100 medications organized by class. Developed by David Kammer, MD, an emergency physician, the pre-loaded medications reflect those that would be used in emergent situations, such as sedatives, paralytics, inhaled bronchodilators, antiarrhythmics, pressors, and analgesics.
However, missing from the list are many medications commonly used in a busy pediatric emergency room or office setting–most notably antibiotics. Though it would be nice to have a starting point, the app developers implicitly note that these medications are to be created based on clinical practice and institutional standards.
New medications may be added to existing categories, or new categories may be added to group medications. A well-made in-app tutorial shows a six minute video that demonstrates how to edit or create new medications.
Other interesting features include a section on “Useful Calculations,” which includes IV fluid rates, vital signs (average, no ranges), and sizes for endotracheal tubes, chest tubes, femoral catheters, nasogastric tubes, and foley catheters.
Additionally, you may set-up multiple dosing calculations for medications (i.e. different doses by age groups or by route of administration). Again, the benefit here is that once you enter an exact or estimated weight, every medication in the app is calculated based on the pre-set dose calculation and displayed.
As downloaded, this app functions strongly in an emergency setting. But short of the user entering all the medication doses and formulations he or she uses in clinical practice, the app needs more versatility to have broader appeal.
First, it lacks information on many common outpatient medications such as antibiotics or asthma controller medications. Second, it lacks information on dilutions. For example, telling a parent to give their child 75mg of acetaminophen is not helpful when the medication is a liquid that comes 160mg/5mL. Telling parents that this equates to 2.5mL, or half a teaspoon, is much more practical.
- Currently $0.99
- Simple design and easy to navigate
- Visually appealing
- Strong initial formulary of 100 medication used primarily in emergencies
- User may customize by adding, sorting, and searching medications
- May account for multiple routes of administration for a single medication (IV, IM, PO, PR) with different doses
- User may enter text notes on dilutions, but volumes are not automatically calculated
- Inability to format text risks cluttering when adding medication information
- The option to customize, sort, and search medications make Peds Meds one of the stronger pediatric dosing apps on the market.
- Emergency room providers may benefit most from this app when taking care of children. Other outpatient providers may find that they need to input many medications that are not pre-loaded, but the app makes that process quite seamless.