Estimating height in bedridden patients

Estimates of pharmacokinetic parameters and evaluation of nutritional status rely on accurate measurement of not only body weight but also height. However, a number of common disabilities and disease processes make it difficult to accurately measure standing height in many patients. Therefore, various formulae based on bones that do not change length have been developed. These methods include knee height, forearm length and demi-span.

Knee height

Knee height is correlated with stature and, until recently, was the preferred method for estimating height in bedridden patients. Knee height is measured using a sliding broad-blade caliper. A device designed for this purpose is commercially available. The patient's height is then estimated using a standard formula.

Forearm length

This method is popular in the UK. The only tool needed is a tape to measure the ulna length between the point of the elbow and the midpoint of the prominent bone of the wrist. This value is then compared with a standardized height conversion chart.¹²

Demi-span

Clinically, the most useful measurement is the demi-span. This method is recommended by the Mini Nutritional Assessment, and, like forearm length, requires no specialized equipment. Demi-span is measured as the distance from the middle of the sternal notch to the tip of the middle finger in the coronal plane. Height is then calculated from a standard formula.

Conclusion

References

1. Hickson M, Frost G. A comparison of three methods for estimating height in the acutely ill elderly population. J Hum Nutr Diet. 2003 Feb;16(1):13-20. [ PubMed ]
2. Brown JK, Feng JY, Knapp TR. Is self-reported height or arm span a more accurate alternative measure of height? Clin Nurs Res. 2002 Nov;11(4):417-32. [ PubMed ]
3. Haboubi NY, Hudson PR, Pathy MS. Measurement of height in the elderly. J Am Geriatr Soc. 1990 Sep;38(9):1008-10. [ PubMed ]
4. Steele MF, Chenier TC. Arm-span, height, and age in black and white women. Ann Hum Biol. 1990 Nov-Dec;17(6):533-41. [ PubMed ] PMID: 2281945 [PubMed - indexed for MEDLINE]
5. Han TS, Lean ME. Lower leg length as an index of stature in adults. Int J Obes Relat Metab Disord. 1996 Jan;20(1):21-7. [ PubMed ]
6. Cockram DB, Baumgartner RN. Evaluation of accuracy and reliability of calipers for measuring recumbent knee height in elderly people. Am J Clin Nutr. 1990 Aug;52(2):397-400. [ PubMed ]
7. Reeves SL, Varakamin C, Henry CJ. The relationship between arm-span measurement and height with special reference to gender and ethnicity. Eur J Clin Nutr. 1996 Jun;50(6):398-400. [ PubMed ]
8. Kwok T, Whitelaw MN. The use of armspan in nutritional assessment of the elderly. J Am Geriatr Soc. 1991 May;39(5):492-6. [ PubMed ]
9. Jarzem PF, Gledhill RB. Predicting height from arm measurements. J Pediatr Orthop. 1993 Nov-Dec;13(6):761-5. [ PubMed ]
10. Mitchell CO, Lipschitz DA. Arm length measurement as an alternative to height in nutritional assessment of the elderly. JPEN J Parenter Enteral Nutr. 1982 May-Jun;6(3):226-9. [ PubMed ]
11. Chumlea WC, Roche AF, Steinbaugh ML. Estimating stature from knee height for persons 60 to 90 years of age. J Am Geriatr Soc. 1985 Feb;33(2):116-20. [ PubMed ]
12. Malnutrition Advisory Group, British Association of Parenteral and Enteral Nutrition. October 2008. Malnutrition Universal Screening Tool. The Malnutrition Universal Screening Tool (MUST) is reproduced here with the kind permission of BAPEN.