Functional Status Scale: New Pediatric Outcome Measure

Murray M Pollack,Kathleen L Meert,Richard Holubkov,Carol Nicholson,Rick Harrison,Penny Glass,Kanwaljeet J S Anand,Jerry Zimmerman,Douglas F Willson,Joseph Carcillo,J Michael Dean,Christopher J L Newth

doi:10.1542/peds.2008-1987

Abstract

The goal was to create a functional status outcome measure for large outcome studies that is well defined, quantitative, rapid, reliable, minimally dependent on subjective assessments, and applicable to hospitalized pediatric patients across a wide range of ages and inpatient environments. Functional Status Scale (FSS) domains of functioning included mental status, sensory functioning, communication, motor functioning, feeding, and respiratory status, categorized from normal (score = 1) to very severe dysfunction (score = 5). The Adaptive Behavior Assessment System II (ABAS II) established construct validity and calibration within domains. Seven institutions provided PICU patients within 24 hours before or after PICU discharge, high-risk non-PICU patients within 24 hours after admission, and technology-dependent children. Primary care nurses completed the ABAS II. Statistical analyses were performed. A total of 836 children, with a mean FSS score of 10.3 (SD: 4.4), were studied. Eighteen percent had the minimal possible FSS score of 6, 44% had FSS scores of >or=10, 14% had FSS scores of >or=15, and 6% had FSS scores of >or=20. Each FSS domain was associated with mean ABAS II scores (P < .0001). Cells in each domain were collapsed and reweighted, which improved correlations with ABAS II scores (P < .001 for improvements). Discrimination was very good for moderate and severe dysfunction (ABAS II categories) and improved with FSS weighting. Intraclass correlations of original and weighted total FSS scores were 0.95 and 0.94, respectively. The FSS met our objectives and is well suited for large outcome studies.

Highlights

A major challenge of pediatrics and its subspecialties is to develop a functional outcome measure that is well defined, quantitative, sufficiently rapid and reliable, minimally dependent on subjective assessments, applicable to as full an age spectrum as possible, and pertinent to hospitalized patients in as many inpatient environments as possible
Each Functional Status Scale (FSS) domain was associated with mean Adaptive Behavior Assessment System (ABAS) II (p
A total of 32% of pediatric intensive care unit (PICU) and high-risk hospitalizations were postoperative with neurosurgery being the predominant surgery and 65% were emergency admissions

Summary

Introduction

A major challenge of pediatrics and its subspecialties is to develop a functional outcome measure that is well defined, quantitative, sufficiently rapid and reliable, minimally dependent on subjective assessments, applicable to as full an age spectrum as possible, and pertinent to hospitalized patients in as many inpatient environments as possible. Since existing measures available for children are either excessively time consuming to conduct [1, 2], available or validated for a limited age spectrum [3], or require too much subjective assessment and future projection by raters [4,5], a new functional outcome measure fulfilling these criteria is especially desirable to enable large outcome studies. The conceptual framework for development of this measure was the activities of daily living scale used in outcome studies of adults. A similar conceptual characterization for children is adaptive behavior, but the formal assessment of adaptive behavior is time consuming and requires specific expertise

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Results

Conclusion