Pediatrics Functional Status Scale (FSS)

Posted on: March 10, 2015 | By: mroyston | Filed under: Pediatric Functional Status Scale

I. Description Information

  • Title: Pediatrics Functional Status Scale (FSS), 1st edition
  • Date of Publication: July 2009
  • Authors: Dr. Murry M. Pollack, MD, Dr. Richard Holubkov, PhD, Dr. Penny Glass, PhD, Dr. J. Michael Dean, MD, Dr. Kathleen L. Meert, MD, Dr. Jerry Zimmerman, MD, PhD, Dr. K. J. S. Anand, MBBS, DPhil, Dr. Joseph Carcillo, MD, Dr. Christopher J.L., Newth, MB, ChB, Dr. Rick Harrison, MD, Dr. Douglas F. Willson, MD, Dr. Carol Nicholson, MD.
  • Publisher: Pediatrics Journal
  • Distributor: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN)
  • Distributor Address: 295 Chipeta Way, P.O. Box 581289, Salt Lake City, UT 84158
  • Cost: accessible in Table 1 online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191069/
  • Purpose: The purpose of this outcome measure is to measure mental status, sensory level, communication, motor function, feeding, and respiratory function to determine the dynamic state of disease and recovery.
  • Type of Test: Observational criteria listed in purpose
  • Target Population: 38 weeks gestation to 18 year-old patients at high risk for functional disability
  • Time Requirements: test administered through chart summarizing each category with estimated time of 20-30 minutes observation to score

II. Test Administration

  • Test Administration: can be subjectively observed by healthcare provider and objectively scored using scale
  • Scoring: given numerical rating of 1 (normal function), 2 (mild dysfunction), 3 (moderate dysfunction), 4 (severe dysfunction), or 5 (very severe dysfunction) in each domain
  • Environment for Testing: setting that allows focus on individual patient with adequate lighting to ensure proper observation
  • Equipment/materials: potentially source of food to measure feeding category if observer is unable to watch patient eat a meal
  • Examiner Qualifications: any clinician with expertise to observe that may include, but is not limited to, pediatrician, pediatric neurologist, pediatric nurse, pediatric developmental psychologist, pediatric physiatrist, pediatric intensivist, and/or pediatric respiratory therapist may be suitable for observation

III. Psychometric Characteristics

  • Standardization/normative Data: score of 6 in all combined categories indicates normally functioning child with increasing scores indicative of dysfunction
  • Evidence of Reliability: very good inter-rater reliability, intraclass correlation of 0.94 (weighted) which indicates high reproducibility, kappa values range from 0.52-0.89 for weight FSS components
  • Evidence of Validity: construct validity established in comparison to adaptive behavior measured by The Adaptive Behavior Assessment System (ABAS) II, discriminative validity established by receiver operating characteristic (ROC) curve analysis using dysfunction groups classified by ABAS-II, predictive validity low as outcome measure cannot predict long-term outcome of disease process
  • MCID-not provided

IV. Summary Comments

  • Strengths: time-efficient, cost-efficient, provides general score of function in child that can be documented/monitored for progress
  • Weaknesses: subjective components (inter-rater discrepancies), not descriptive of child’s complete function, limited categories that do not encompass total function of child
  • Clinical Application: when a clinician is short on time but needs to assess functional status of child and gives general progression of function that can be broken down by category

V. References

Pollack M, Holubkov R, Nicholson C, et al. Functional status scale: new pediatric outcome measure. Pediatrics. July 2009;124(1):e18-28.

Pollack, M, Holubkov R, Funal T, et al. Relationship between the functional status scale and the pediatric overall performance category and pediatric cerebral performance category scales. JAMA Pediatrics. July 2014;168(7):671-676.

VI. Article Summary:

The objective of this study was to determine new morbidities associated with pediatric critical care. The researchers monitored the morbidity of 5,017 randomly selected patients from eight medical and cardiac PICUs in the Collaborative Pediatric Critical Care Research Network (CPCCRN). The patient morbidities were analyzed using a comparison of baseline to hospital discharge scores of the Pediatrics Functional Status Scale (FSS). A new morbidity was defined as an increase in the patient’s FSS by greater than or equal to 3 from baseline throughout the progression of hospital stay. The authors aimed to determine whether the FSS is an appropriate objective measure to monitor whether morbidities have developed in patients ranging from newborn to 18 years of age. The baseline scores were determined through analysis of past medical history and parent report and hospital discharge scores were recorded at the end of stay. The FSS measures mental status, sensory, communication, motor function, feeding, and respiratory function of the subjects.

The results of this study found that the FSS was appropriate in determining the new morbidities of the population in this study. New morbidity was evident in 4.8% of the patients with PICU deaths in 2.0% and hospital deaths on 2.4%. It was found that the highest level of new morbidity occurs in patients with neurological diagnoses, followed by cardiovascular disease, cancer, and congenital cardiovascular disease. The categories that had the highest increase in score were the respiratory, motor, and feeding function domains. There was a clinically significant difference between the morbidity and mortality among the sites, as morbidity was significantly higher. The relevance of morbidity rates in this population relate to the outcome assessment of function in the pediatric setting. The authors of this study determined that the FSS is a functionally appropriate outcome measure to determine morbidity, which may correlate with pediatric functional outcomes and contribute to appropriate care.

Pollack, M, Holubkov R, Funal T, et al. Pediatric Intensive Care Outcomes: Development of New Morbidities During Pediatric Critical Care. Pediatr Crit Care Med. 2014;15(9):821-827.

 

2 responses to “Pediatrics Functional Status Scale (FSS)”

  1. dsorenson says:

    The FSS seems like a great test and measure to examine more than just one aspect of a child’s functional ability; i.e. it looks at psychomotor aspects as well as psychosocial aspects of functionality. I think that it would be most beneficial for quick use in the clinic in order to examine each specific subgroup of a child’s overall ability.

  2. kchildress says:

    This test outcome measure seems to be good for children who do not have a specific diagnosis but may present with some functional inabilities. As a general outcome measure it seems like it would be a good to utilize in the clinic, especially since there are many outcome measures that only target a specific diagnosis or have more normative data and MCIDs for those populations. Is this the best functional scale used in pediatrics at this time?

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