Tests & Measures: A Resource for Pediatric Physical Therapy Practitioners

Pediatric Functional Status Scale, Update

All information in the last post is up to date. However, I have added some things that were not included.

Pediatric Functional Status Scale UPDATE
I. Descriptive Information

A. Target population and age:Pediatric hospitalized patients, used for large pediatric outcome studies

II. Psychometric Characteristics

A. Type of information, resulting from testing: predict current function, morbidity, and mortality. Scores of 6-7= good, 8-9 = mildly abnormal, 10-15= moderately abnormal, 16-21= severely abnormal, more than 21= very severely abnormal

B. Discriminative: very good with moderate and severe dysfunction

C. Predictive: predictive of morbidity and mortality

Article:

Pollack MM, Holubkov R, Funai T, et al. Simultaneous Prediction of New Morbidity, Mortality, and Survival Without New Morbidity From Pediatric Intensive Care: A New Paradigm for Outcomes Assessment. Crit Care Med. 2015;43(8):1699-709.

The purpose of this article was to test the idea that morbidity affecting functional status was associated with physiological dysfunction in the PICU setting and could predict mortality to provide outcome prediction for morbidity, mortality, and survival. This article developed a prediction model using the pediatric functional status scale (FSS), pediatric risk of mortality III score (PRISM), and the data from 10,078 patients at seven sites in a trichotomous outcomes pediatric critical care study. The patients were newborns to less than 18 years old and were randomly selected from the general, medical, and cardiac PICUs. The first PICU admission was included and patients with vital signs not harmonious with life after 2 hours and that remained in the hospital after the study was completed were excluded from the study. All data was retrieved through medical records or conversations with healthcare providers. The outcomes used were the FSS at baseline and discharge and the PRISM within the first four hours of care.

The results showed that with increasing PRISM scores there was an increase in morbidity until the risk of mortality was very high, in which the morbidity rates decreased with the trichotomous relationships. The final trichotomous model that was created to predict morbidity and ultimately mortality included; age, admission source, cardiac arrest, a diagnosis of acute or chronic cancer, primary system of dysfunction, baseline FSS, and PRISM scores divided into neurologic and non-neurologic. A diagnosis of cancer and FSS score were significant independent predictors of mortality within the study. There was 112 morbidities observed with 113.6 predicted, and 61 deaths observed with 67.1 predicted. One strength of this article included a large sample size which increased generalizability among pediatric patients. The limitations of this article included a lack of long term follow up, the data abstracters were not blinded (possible bias), and the data collection process was not reassessed for accuracy. In conclusion, new morbidities associated with functional decline/status were correlated with mortality when using the trichotomous model with PRISM and FSS in the PICU setting. Using the FSS as a morbidity outcome was deemed practical, appropriate, and worked smoothly with this large study. The ability to refine assessment of outcomes in children that survive can open more doors in order to improve patient outcomes and patient care overall.