Abstract
IntroductionEvaluating the pre-morbid functional status in critically ill patients is important and frequently done using the physical component score (PCS) of the Short Form 36, although this approach has its limitations. The Academic Medical Center Linear Disability Score (ALDS) is a recently developed generic item bank used to measure the disability status of patients with a broad range of diseases. We aimed to study whether proxy scoring with the ALDS could be used to assess the patients' functional status on admission for cardiac care unit (CCU) or ICU patients and how the ALDS relates to the PCS using the Short Form 12 (SF-12).MethodsPatients and proxies completed the ALDS and SF-12 score in the first 72 hours following ICU scheduled surgery (n = 14), ICU emergency admission (n = 56) and CCU emergency admission (n = 70).ResultsIn all patients (n = 140) a significant intra-class correlation was found for the ALDS (0.857), the PCS (0.798) and the mental component score (0.679) between patients and their proxy. In both scheduled and emergency admissions, a significant correlation was found between patients and their proxy for the ALDS, although the lowest correlation was found for the ICU scheduled admissions (0.755) compared with the ICU emergency admissions (0.889). In CCU patients, the highest significant correlation between patients and proxies was found for the ALDS (0.855), for the PCS (0.807) and for the mental component score (0.740).ConclusionsRelatives in close contact with critically ill patients can adequately reflect the patient's level of disability on ICU and CCU admission when using the ALDS item bank, which performed at least as well as the PCS. The ALDS could therefore be a useful alternative for the PCS of the SF-12.
Highlights
Evaluating the pre-morbid functional status in critically ill patients is important and frequently done using the physical component score (PCS) of the Short Form 36, this approach has its limitations
The aims of our study were to evaluate whether proxy scoring with the Academic Medical Center Linear Disability Score (ALDS) and the Short Form 12 (SF-12) can be used to assess the patients’ functional status on admission to the coronary care unit (CCU) or ICU and, secondly, to evaluate how the physical disability score of the ALDS relates to the PCS using the SF-12
Scheduled ICU admissions versus emergency ICU admissions In both scheduled and emergency admissions, a significant excellent-good intra-class correlation was found between patients and their proxy for the ALDS, the lowest correlation was found for the ICU scheduled admissions (0.755) compared with the ICU emergency admissions (0.889)
Summary
Evaluating the pre-morbid functional status in critically ill patients is important and frequently done using the physical component score (PCS) of the Short Form 36, this approach has its limitations. The Academic Medical Center Linear Disability Score (ALDS) is a recently developed generic item bank used to measure the disability status of patients with a broad range of diseases. The assessment of the functional health status on ICU admission is important to judge the biological reserve of a patient in relation to final outcome [5,6] Current measures such as the physical component score (PCS) of the widely used SF-36, have several limitations; for instance, the SF-36 scores are used to calculate a summarised score with an inherent loss of information. The Academic Medical Center Linear Disability Score (ALDS) is a recently developed generic item bank that measures the disability status of patients with a broad range of diseases, as expressed by the ability to perform activities in daily living [7]. The ALDS has not, been validated for critically ill patients or for use by proxies to estimate ICU preadmission functional status
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