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Skin to Intramuscular Compartment Thigh Measurement by Ultrasound in Pediatric Population

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Pediatric obesity threatens the efficacy of medications given intramuscularly. In anaphylactic patients, epinephrine auto-injector needle lengths are potentially too short to reach the muscle compartment in patients with elevated body habitus. The objective of the study was to determine needle-length requirements for intramuscular injections in pediatric patients.

Methods: We used ultrasound to measure the distance from skin to muscle compartment of the thigh in 200 pediatric patients of various weight and body mass index who presented to the emergency department.

Results: Patients with higher body mass index had an increased distance to muscle and bone. If current recommendations were followed, 5% of patients within the EpiPen adult weight category and 11% of patients within the Centers for Disease Control and Prevention weight category would have potentially used a needle inadequate in length for intramuscular injections.

Conclusion: With the increase in childhood obesity, needle lengths may be too short to effectively deliver medications to the intramuscular compartment. Needle length should be evaluated to accommodate pediatric patients with increased skin to muscle distance.

No MeSH data available.


Related in: MedlinePlus

Body mass index predicts distance to muscle. Regression analysis was performed from ultrasound measurements from skin to muscle and analyzed by gender (A) and ethnicity (B). Best fit regression lines are represented for gender and ethnicity. The equation of the line for total patients was Y=0.046x–0.2142, R2=0.3515.
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f1-wjem-18-479: Body mass index predicts distance to muscle. Regression analysis was performed from ultrasound measurements from skin to muscle and analyzed by gender (A) and ethnicity (B). Best fit regression lines are represented for gender and ethnicity. The equation of the line for total patients was Y=0.046x–0.2142, R2=0.3515.

Mentions: The mean BMI for all subjects combined averaged to 19 with standard deviation of +/− 5.3. The mean depth to muscle was 0.72cm. Regression analysis determined that BMI significantly predicted the distance to muscle and that subjects with higher BMI tended to have a greater distance to muscle, with an R2 value, which indicates how well the linear model fits the data, of 0.3515 and a p-value of <0.001 or Pearson correlation coefficient of 0.6 (Figure 1). Additionally, regression analysis determined that BMI significantly predicted the distance to bone and that subjects with higher BMI tended to have greater distance to bone, with an R2 value of 0.6429 and a p-value of <0.001 or a Pearson correlation coefficient of 0.8. The mean depth to bone was 3.84cm (Figure 2). When analyzed by gender and ethnicity, female and African-American patients had higher trends in BMI and distance to muscle and distance to bone compared to white males. The Hispanic population included less than five patients (Figures 1–2).


Skin to Intramuscular Compartment Thigh Measurement by Ultrasound in Pediatric Population
Body mass index predicts distance to muscle. Regression analysis was performed from ultrasound measurements from skin to muscle and analyzed by gender (A) and ethnicity (B). Best fit regression lines are represented for gender and ethnicity. The equation of the line for total patients was Y=0.046x–0.2142, R2=0.3515.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5391899&req=5

f1-wjem-18-479: Body mass index predicts distance to muscle. Regression analysis was performed from ultrasound measurements from skin to muscle and analyzed by gender (A) and ethnicity (B). Best fit regression lines are represented for gender and ethnicity. The equation of the line for total patients was Y=0.046x–0.2142, R2=0.3515.
Mentions: The mean BMI for all subjects combined averaged to 19 with standard deviation of +/− 5.3. The mean depth to muscle was 0.72cm. Regression analysis determined that BMI significantly predicted the distance to muscle and that subjects with higher BMI tended to have a greater distance to muscle, with an R2 value, which indicates how well the linear model fits the data, of 0.3515 and a p-value of <0.001 or Pearson correlation coefficient of 0.6 (Figure 1). Additionally, regression analysis determined that BMI significantly predicted the distance to bone and that subjects with higher BMI tended to have greater distance to bone, with an R2 value of 0.6429 and a p-value of <0.001 or a Pearson correlation coefficient of 0.8. The mean depth to bone was 3.84cm (Figure 2). When analyzed by gender and ethnicity, female and African-American patients had higher trends in BMI and distance to muscle and distance to bone compared to white males. The Hispanic population included less than five patients (Figures 1–2).

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Pediatric obesity threatens the efficacy of medications given intramuscularly. In anaphylactic patients, epinephrine auto-injector needle lengths are potentially too short to reach the muscle compartment in patients with elevated body habitus. The objective of the study was to determine needle-length requirements for intramuscular injections in pediatric patients.

Methods: We used ultrasound to measure the distance from skin to muscle compartment of the thigh in 200 pediatric patients of various weight and body mass index who presented to the emergency department.

Results: Patients with higher body mass index had an increased distance to muscle and bone. If current recommendations were followed, 5% of patients within the EpiPen adult weight category and 11% of patients within the Centers for Disease Control and Prevention weight category would have potentially used a needle inadequate in length for intramuscular injections.

Conclusion: With the increase in childhood obesity, needle lengths may be too short to effectively deliver medications to the intramuscular compartment. Needle length should be evaluated to accommodate pediatric patients with increased skin to muscle distance.

No MeSH data available.


Related in: MedlinePlus