Pediatric Functional Status Scale, Update 3
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Article Summary:
Pereira GA, Schaan CW, Ferrari RS. Functional evaluation of pediatric patients after discharge from the intensive care unit using the Functional Status Scale. Revista Brasileira de Terapia Intensiva. 2017;29(4):460-465. doi:10.5935/0103-507X.20170066.
The objective of this article was to evaluate the functional status of pediatric patients after discharge from an intensive care unit using the Pediatric Functional Status Scale. The study compared the Pediatric Index of Mortality 2, time spent on mechanical ventilation, and length of stay in the pediatric intensive care unit between patients with different levels of functional impairments.
This was a cross sectional study with 50 participants. 60% of the participants were male and the median age was 19 months. The evaluation done with the Functional Status Scale was done on the first day after discharge from the pediatric intensive care unit. The Index of Mortality 2 was done on day of admission to predict mortality rate.
The results of this study presented an average Functional Status Scale score of 11 (7-15). The highest scores, which reveal increased impairment, were found in the “motor function” and “feeding” categories. This study found that when compared to those who were not re-admitted, those who were re-admitted had poorer scores in the feeding, respiratory, and motor categories. In addition, those patients that were re-admitted had higher mortality rates according to the Pediatric Index of Mortality 2.
One of the strengths of this article was that it is one of the first articles to look at the correlation between functional status at discharge and the occurrence of re-admission. This study brought to light that patients with decreased functional status at discharge may need to be monitored more closely after a stay in the hospital that other patients. A limitation of this study was that the test was completed once after discharge, which may not capture the true functional status of the patient. That patient may have had increased stress from shift in environment, or may be having a good day/hour which could show increased function that is not necessarily indicative of the patient’s actual level of function. I would have liked to see multiple trials at different time periods to get a true read of the patient’s function.
This study concluded that there was a high prevalence of moderate dysfunction regarding functional status after discharge from a pediatric intensive care unit. The greatest impairments were found in motor categories and not in the cognitive categories. This study acknowledged the relationship between worse scores on the functional status scale and readmission, higher predictive mortality rate on the Index of Mortality 2 and increased functional limitations. This increase in functional impairment, lead to longer hospital stays and longer time spent on mechanical ventilation.
2 responses to “Pediatric Functional Status Scale, Update 3”
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Nicole, great summary! It is interesting to think they can perform a functional outcome measure on a patient that is so young. How did they perform the actual function assessment? Did the article mention any causes of the decreased function in patients that were re-admitted? I find it intriguing that the greater impairments were found in the functional/motor categories and not the cognitive categories, like a lot of other patients who spend a significant amount of time in the ICU.
Thank you for your questions Danielle! On the FSS, they look at the following categories, mental status,sensory status, posture/tone, gross motor movement, physical impairment, functional feeder, respiratory status, social responsivity, communication vocal,communication non vocal and then rank them based on level of impairment. A lower score would indicate typical function and a higher score would indicate the patient’s function was highly impaired. The article did say that those who were re-admitted had worse scores at discharge in the motor, feeding, and respiratory domains. The article did not go into detail about the reasons why the patient’s had decreased function-just in what domains there was a marked decrease in function.