title: Comparison of three techniques for calculation of the Parkland formula to aid fluid resuscitation in paediatric burns.
abstract: BACKGROUND
  Inadequate fluid resuscitation of acute burns may result in hypovolaemic shock. Excessive fluid resuscitation may result in fluid overload. A nomogram which uses the popular Parkland formula and '4-2-1' regime has been recently described to facilitate the calculation of fluid requirements in children during the first 24 h following burn injury.
  
  
  OBJECTIVE
  To compare the accuracy and speed of calculation of three different methods (pen and paper, electronic calculator and nomogram), which all use the Parkland formula and '4-2-1' regime to calculate maintenance and resuscitation fluid requirements for children in the first 24 h after burn injury.
  
  
  METHODS
  A randomised volunteer study using computer-generated simulated patient data.
  
  
  METHODS
  Welsh Centre for Burns, ABM University Local Health Board, Swansea, UK. Data were collected between February 2011 and October 2011.
  
  
  METHODS
  The group consisted of 36 volunteers including trainee and consultant surgeons and anaesthetists.
  
  
  METHODS
  Thirty-six participants performed 318 calculations, using each of the three methods of calculation up to three times.
  
  
  METHODS
  Accuracy, speed and acceptability of the different methods.
  
  
  RESULTS
  For nomogram, calculator and pen and paper: magnitude of error [low (≥25%), medium (≥50%) and high (≥75%)]: [5.7, 4.7 and 3.8%], [12.1, 12.1 and 7.5%], [28.6, 21.9 and 16.2%]; [P <0.001, P = 0.001 and P = 0.006]. Calculation time: [s; mean (SD)]: 121 (48), 109 (52) and 240 (140); P <0.001. The mean (SD) of the difficulty scores were 17.3 (13), 20.6 (13.4) and 62.2 (23.4); P <0.001.
  
  
  CONCLUSIONS
  The nomogram was the most accurate method of calculating fluid requirements using the Parkland formula, was only slightly slower than the electronic calculator and was deemed the easiest to use. The nomogram is also low cost, robust, and provides a rapid means of detecting and preventing the large errors that we have shown can occur when an electronic device is used as the primary method of resuscitation fluid calculation. We, therefore, suggest that the nomogram is a suitable method for the calculation of the Parkland formula to guide resuscitation and maintenance fluid requirements in the first 24 h of paediatric burns or for cross-checking the results obtained by other means of calculation.
authors.affiliation: School of Medicine, Swansea University, Swansea, Cardiff & Vale University Local Health Board, Cardiff, UK.
authors.forename: Owen
authors.initials: O
authors.lastname: Bodger
authors.forename: Abrie
authors.initials: A
authors.lastname: Theron
authors.forename: David
authors.initials: D
authors.lastname: Williams
mesh_terms: D000465:Algorithms; D001830:Body Surface Area; D002056:Burns / Q000628:therapy*; D002648:Child; D003198:Computer Simulation; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D049451:Nomograms; D011897:Random Allocation; D015203:Reproducibility of Results; D012151:Resuscitation / Q000379:methods*; D012769:Shock / Q000517:prevention & control; D013997:Time Factors