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Measuring Height in the Intensive Care Unit: Can We Do Better? FREE TO VIEW

Karim Nathan, MD; Abhishek Agarwal, MD; Priya Kamath, MD; Girish Rao; Abhinav Agrawal; Deborah Park, MD
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Cooper University Hospital, Philadelphia, PA

Chest. 2015;148(4_MeetingAbstracts):224A. doi:10.1378/chest.2281602
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SESSION TITLE: Critical Care Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Height is a pivotal value in the care of critically ill patients. It is used to determine ideal body weight, ventilator settings, drug dosing, infusion rates, cardiac indices, and more. In many intensive care units, including our own, height is often obtained by visual estimation or by report of the patient’s family. These methods may lead to inaccuracies in the documented height that may in turn distort calculations. It is the aim of this study to introduce a systematic means of recording height in our ICU.

METHODS: Forty-three patients were measured using a “book-end” device demonstrated in a previously published nursing quality improvement study. This measurement tool requires that the patient be laid supine with one bookend placed at the patient’s heels and one at the patient’s head. A tape measure was then used to measure the distance between the two ends, each one angled perpendicularly from the bed. Patients were excluded from the study if they could not safely or comfortably be laid supine due to pain, neurological injury or congestive heart failure. Baseline characteristics of patients were recorded, including ventilator status and the calculated ideal body weight (IBW).

RESULTS: Of the 43 patients, 27 were male and 16 were female. 17 of the 43 (39.5%) were mechanically ventilated. A Bland-Altman analysis was used to determine the degree of disagreement between measured and documented heights. The average difference was -0.660 inches (p = 0.024). The average difference for females was -1.167 and for males was -0.3657; there was no statistically significant difference between recorded and measured differences between male and female heights (p = 0.6103).

CONCLUSIONS: There is a significant difference between estimated and reported heights and those obtained by direct measurement. Several methods of measuring height are described in the literature, including lower leg and forearm length and portable stadiometry. There is not yet definitive data identifying the most accurate method with respect to the gold standard of height measurement, which is by standing stadiometry. Regardless, we believe that a systematic method for obtaining height may be beneficial in producing more accurate ICU parameters.

CLINICAL IMPLICATIONS: Performance improvement projects such as this can be applied on an institution-by-institution basis and can lead to more acurate ICU parameters, including mechanical ventilation settings and ideal body weights.

DISCLOSURE: The following authors have nothing to disclose: Karim Nathan, Abhishek Agarwal, Priya Kamath, Girish Rao, Abhinav Agrawal, Deborah Park

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