by: Sumeet Banker, MD, MPH
It’s no secret – one of the most time- and labor-intensive parts of pediatric medicine is medication dosing.
It’s hard enough for those of us who are pediatricians, not to mention those who infrequently provide pediatric care in family practices, emergency rooms, and operating rooms.
Selecting a drug dose and frequency that is not only accurate but also practical and convenient can be the difference between a healthy and sick child. Not to mention that incorrect dosing may result in serious consequences for small children.
PediCalc is an exquisitely simple app developed by MobileMed that provides a customizable quick reference to dose calculations for commonly used medications in a two-screen format. Yet despite its functionally simple design, it falls short in some key areas.
As with most dose calculators, the first screen is a prompt for weight entry. You may estimate weight using age if the patient’s condition inhibits your ability to obtain an accurate weight.
However, unlike other dosing apps, weight is only accepted in kilograms. I make this distinction because, even though all drugs are dosed by kilogram of body weight, most parents and caregivers in America would probably provide a recent weight in pounds. For a critically ill child, it just seems tedious to have to convert the weight yourself when the app should be able to easily do this.
Once a weight is entered/estimated, you are taken to a screen called “My Drugs” a single screen containing automatic dose calculations for a listing of medications. For each medication, it includes per-kilo dosing and calculated dose, as well as drug dilution and calculated volume. There is also an area for free text comments for each drug, though this is extremely limited to approximately 30 characters.
The “Emergency” list contains a second set of drugs to be used in critical settings, though there is no difference in terms of dosage calculations. This is essentially a second list of medications with a red background, otherwise identical to the “My Drugs” page.
One of the major benefits of the app is the ability to customize medication lists and add drugs at doses that correspond to your practice habits. This can be performed quite easily by entering 1) the name of the drug, 2) dose per kilogram, and optionally, 3) notes regarding frequency or other comments, and 4) drug dilution ratio. Though, again, space in the notes section is very limited.
You may also move and sort medications by any criteria you choose – practice relevance, alphabetical, category, etc.
There are significant limitations with this app. First, the main screens include some basic vital signs – heart rate and systolic blood pressure – based on age. However, this age is calculated based on weight norms, so it may not be appropriate for obese or malnourished children (e.g. anyone over 50kg is assumed to be 14 years old). Additionally, there is no indication of what the ranges represent – the middle 50 percent or 90 percent, or something altogether different.
Second, the app comes pre-loaded with just 15 medications (seven “My Drugs” and eight “Emergency” meds). Though it is billed as an app that is completely customizable with the ability to input commonly used medication at institutional dosing, it would be nice to start with a few more (particularly considering the fact that the pre-loaded sedative and paralytic drugs are not typically used by most pediatric providers).
Third, though the drug list may be sorted by the user, there are no categories for easy grouping, such as antibiotics, pressors, sedatives, etc. The app developers state that everything is on one screen, thereby decreasing the time spent searching in sub-menus. However, I found that it would take longer to scroll through a list of 50-100 medications for something like Unasyn rather than one extra click to enter an antibiotics subgroup containing 15 drugs.
Finally, there are no citations for the drug doses, weight/age calculation, or recourse for error reporting. For example, there is no explanation of how age is used to estimate weight. I could not find a citation of growth charts or other standards used. Are estimated weights calculated based on WHO growth charts’ 50th percentile for age? Is it overestimated to maximize efficacy or underestimated to guarantee safety? Particularly when it comes to dosing medications in children, clear citations and quality control are critical. Unfortunately, this is an area where the app is currently deficient.
I like the concept behind PediCalc that keeps it functionally simple, but I am still on the hunt for the perfect pediatric dosing app that combines one-touch calculations with the extensive formulary needed to appropriately care for a diverse population of children.
- Useful for finding one-time dosing for medications used in emergency situations
- Calculates drug volume for pediatric suspensions
- List customization
- Weight may only be entered in kilograms
- Very limited space for free text comments/notes (regarding frequency, route, suspension volume, etc.)
- No option to create categories to sort drugs by class
- Preloaded with few medications
- Lack of citations for drug dosing and methodology for age/weight estimates
- No quality control or error reporting system cited
- PediCalc app occupies a very specific niche as it currently stands
- The app’s design is functionally simple and easy to navigate, but lacks a layout to support the amount of content necessary to appeal to a wider audience.
- The app still needs a fair amount of work to make sure it is a trusted resource