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Paediatrics
Nearly half of paediatric doses off-protocol
Deviations From Recommended Drug Dosing in the Prehospital Treatment of Pediatric Patients
Prehospital Emergency Care · 2026-09-29 · Added 3 October 2026
US quality-registry cohort of 386 prehospital paediatric medication administrations found 46.4% deviated at least 20% from protocolised dosing — mostly underdoses — with ondansetron (aOR 36.9) and the intranasal route (aOR 7.3) the biggest drivers.
- Study type
- Cohort
- Design
- Retrospective quality-improvement registry cohort
- Participants
- 386 medication administrations in 240 children across nine agencies
- Main finding
- 46.4% of doses deviated ≥20% from recommended (79.9% underdoses); deviation was highest for ondansetron (85.3%) and via the intranasal route (69.7%); weight-estimation error was not associated
- Caveat
- Single US metropolitan system with uniform protocols, and registry-flagged deviations may capture deliberate titration within permitted ranges
- Bottom line
- Hypothesis-generating
Why it matters in Australia (High relevance). Weight-based paediatric dosing and intranasal drug delivery are standard Australian practice, so the error patterns translate directly to our trucks.
Learning goal
Update my approach to paediatric medication dosing, particularly intranasal and antiemetic administration, to reduce underdosing.
More
- Topic: Paediatrics
- Daily scan: 3 October 2026
- Podcast: Paramedic Papers Daily, 3 October 2026
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