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Updated: Jun 22, 2026
Measuring the Functional Abilities of Children Aged 3-6 Years Old with Observational Methods and Computer Tools
Published on: June 20, 2020
Functional Status Scale: new pediatric outcome measure
Murray M Pollack1, Richard Holubkov, Penny Glass
1Phoenix Children's Hospital, 1919 E. Thomas Rd, Phoenix, AZ 85016. mpollack@phoenixchildrens.com.
Insights
The Functional Status Scale (FSS) is a reliable tool for assessing hospitalized children. This quantitative measure is well-suited for large pediatric outcome studies.
Area of Science:
- Pediatric critical care medicine
- Healthcare outcomes research
- Functional status assessment
Background:
- Assessing functional status in hospitalized pediatric patients is crucial for outcome studies.
- Existing measures may lack the quantitative, rapid, and reliable characteristics needed for large-scale research.
- A well-defined, objective measure is required to evaluate diverse pediatric inpatient populations.
Purpose of the Study:
- To develop and validate the Functional Status Scale (FSS) as a quantitative outcome measure for hospitalized pediatric patients.
- To ensure the FSS is rapid, reliable, and minimizes subjective assessments.
- To establish applicability across various ages and inpatient settings.
Main Methods:
- The Functional Status Scale (FSS) includes domains for mental, sensory, communication, motor, feeding, and respiratory status, scored 1-5.
- Construct validity was assessed using the Adaptive Behavior Assessment System II (ABAS II).
- Data were collected from 836 children across seven institutions, including PICU patients and technology-dependent children, with primary care nurses completing the ABAS II.
Main Results:
- The study included 836 children with a mean FSS score of 10.3.
- Significant associations were found between FSS domains and ABAS II scores (P < .0001), with improvements after reweighting.
- The FSS demonstrated very good discrimination for moderate to severe dysfunction, with high reliability (ICCs 0.95-0.94).
Conclusions:
- The Functional Status Scale (FSS) successfully meets the objectives for a functional status outcome measure.
- The FSS is well-defined, quantitative, rapid, and reliable.
- The FSS is suitable for large-scale pediatric outcome studies across diverse inpatient environments.
Objective:
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.
Methods:
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.
Results:
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.
Conclusions:
The FSS met our objectives and is well suited for large outcome studies.
