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Resting energy expenditure in severely burned children: analysis of agreement between indirect calorimetry and prediction equations using the Bland-Altman method.
Burns 2006; 32(3):335-42B

Abstract

INTRODUCTION

Knowledge of a child's resting energy expenditure (REE) is essential in optimizing nutritional support for severely burned children. The provision of adequate nutritional support is vital in order to avoid the consequences of malnutrition or overfeeding. Nutritional requirements for severely burned children are often based on equations for estimates of REE. The accuracy of the predictive equations of REE has been questioned and many authors have advocated the measurement of REE. This study tests the hypothesis that estimates of REE vary significantly from measured REE (MREE) in a population of severely burned children, and are not accurate for determining nutritional requirements.

METHODS

In 91 severely burned children aged between 3 and 18 years, REE was measured by indirect calorimetry (MREE) at the height of the hypermetabolic response and compared with predicted equations (PREE) from the Food and Agriculture/World Health Organization/United Nations University (FAO/WHO/UNU), Schofield-HW and Harris-Benedict. Agreement between indirect calorimetry and predicted equations was assessed following the Bland-Altman method.

RESULTS

In the entire cohort group, predicted REE from all three equations were significantly lower compared to MREE (p<0.05). There was poor agreement between the MREE and predicted using all three equations. The Schofield-HW equation showed the lowest mean MREE-PREE difference: 635+/-526 kcal/day (limits of agreement -608 and 1878 kcal/day; 95% confidence interval for the bias 525-745 kcal/day). Additionally, all three equations under predicted REE and were not significantly different from one another (p=0.98).

CONCLUSIONS

Until more accurate predicted equations are developed, we recommend indirect calorimetry measurements for determining resting energy expenditure in severely burned children.

Authors+Show Affiliations

Medical Staff Administration, Shriners Hospitals for Children, and Department of Surgery, The University of Texas Medical Branch, 815 Market Street, Galveston, TX 77550, USA. oesuman@utmb.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

16529869

Citation

Suman, Oscar E., et al. "Resting Energy Expenditure in Severely Burned Children: Analysis of Agreement Between Indirect Calorimetry and Prediction Equations Using the Bland-Altman Method." Burns : Journal of the International Society for Burn Injuries, vol. 32, no. 3, 2006, pp. 335-42.
Suman OE, Mlcak RP, Chinkes DL, et al. Resting energy expenditure in severely burned children: analysis of agreement between indirect calorimetry and prediction equations using the Bland-Altman method. Burns. 2006;32(3):335-42.
Suman, O. E., Mlcak, R. P., Chinkes, D. L., & Herndon, D. N. (2006). Resting energy expenditure in severely burned children: analysis of agreement between indirect calorimetry and prediction equations using the Bland-Altman method. Burns : Journal of the International Society for Burn Injuries, 32(3), pp. 335-42.
Suman OE, et al. Resting Energy Expenditure in Severely Burned Children: Analysis of Agreement Between Indirect Calorimetry and Prediction Equations Using the Bland-Altman Method. Burns. 2006;32(3):335-42. PubMed PMID: 16529869.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Resting energy expenditure in severely burned children: analysis of agreement between indirect calorimetry and prediction equations using the Bland-Altman method. AU - Suman,Oscar E, AU - Mlcak,Ronald P, AU - Chinkes,David L, AU - Herndon,David N, Y1 - 2006/03/10/ PY - 2005/05/19/received PY - 2005/10/27/accepted PY - 2006/3/15/pubmed PY - 2006/6/30/medline PY - 2006/3/15/entrez SP - 335 EP - 42 JF - Burns : journal of the International Society for Burn Injuries JO - Burns VL - 32 IS - 3 N2 - INTRODUCTION: Knowledge of a child's resting energy expenditure (REE) is essential in optimizing nutritional support for severely burned children. The provision of adequate nutritional support is vital in order to avoid the consequences of malnutrition or overfeeding. Nutritional requirements for severely burned children are often based on equations for estimates of REE. The accuracy of the predictive equations of REE has been questioned and many authors have advocated the measurement of REE. This study tests the hypothesis that estimates of REE vary significantly from measured REE (MREE) in a population of severely burned children, and are not accurate for determining nutritional requirements. METHODS: In 91 severely burned children aged between 3 and 18 years, REE was measured by indirect calorimetry (MREE) at the height of the hypermetabolic response and compared with predicted equations (PREE) from the Food and Agriculture/World Health Organization/United Nations University (FAO/WHO/UNU), Schofield-HW and Harris-Benedict. Agreement between indirect calorimetry and predicted equations was assessed following the Bland-Altman method. RESULTS: In the entire cohort group, predicted REE from all three equations were significantly lower compared to MREE (p<0.05). There was poor agreement between the MREE and predicted using all three equations. The Schofield-HW equation showed the lowest mean MREE-PREE difference: 635+/-526 kcal/day (limits of agreement -608 and 1878 kcal/day; 95% confidence interval for the bias 525-745 kcal/day). Additionally, all three equations under predicted REE and were not significantly different from one another (p=0.98). CONCLUSIONS: Until more accurate predicted equations are developed, we recommend indirect calorimetry measurements for determining resting energy expenditure in severely burned children. SN - 0305-4179 UR - https://www.unboundmedicine.com/medline/citation/16529869/Resting_energy_expenditure_in_severely_burned_children:_analysis_of_agreement_between_indirect_calorimetry_and_prediction_equations_using_the_Bland_Altman_method_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0305-4179(05)00321-9 DB - PRIME DP - Unbound Medicine ER -