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Relationship between the functional status scale and the pediatric overall performance category and pediatric
Murray M Pollack1, Richard Holubkov2, Tomohiko Funai2
1Department of Critical Care Medicine, Phoenix Children's Hospital, Phoenix, Arizona2Department of Child Health, University of Arizona College of Medicine-Phoenix.
Insights
The Functional Status Scale (FSS) and Pediatric Overall Performance Category/Pediatric Cerebral Performance Category (POPC/PCPC) scales are closely associated in pediatric critical care. While FSS scores increase with worsening POPC/PCPC ratings, FSS offers greater precision for functional status assessment.
Area of Science:
- Pediatric Critical Care Medicine
- Functional Status Assessment
- Clinical Outcomes Research
Background:
- Functional status assessment is crucial for evaluating outcomes in pediatric critical care studies.
- The Functional Status Scale (FSS) and the Pediatric Overall Performance Category/Pediatric Cerebral Performance Category (POPC/PCPC) scales are commonly used methods.
- Assessing the relationship between these scales is important for large-sample studies.
Purpose of the Study:
- To investigate the relationships between the Functional Status Scale (FSS) and the Pediatric Overall Performance Category/Pediatric Cerebral Performance Category (POPC/PCPC) scales.
- To determine the association between FSS and POPC/PCPC scores at different time points (PICU admission and discharge).
- To evaluate the dispersion of FSS scores within POPC/PCPC ratings and the relationship between FSS neurologic components (FSS-CNS) and PCPC.
Main Methods:
- Prospective cohort study conducted across 7 sites and 8 children's hospitals.
- Inclusion of all pediatric intensive care unit (PICU) patients younger than 18 years.
- Collection of FSS and POPC/PCPC scores at PICU admission (baseline) and PICU discharge.
Main Results:
- A significant association (P < .001) was found between FSS and POPC/PCPC scores, with FSS scores increasing with worsening POPC/PCPC ratings.
- Substantial dispersion of FSS scores within each POPC/PCPC rating was observed, increasing with severity.
- Significant differences in FSS-CNS scores were noted across PCPC ratings, indicating a correlation.
Conclusions:
- The FSS and POPC/PCPC systems demonstrate a close association in pediatric critical care.
- While FSS scores correlate with POPC/PCPC severity, the FSS provides a more objective and granular assessment.
- The dispersion of FSS scores suggests limitations in the precision of the POPC/PCPC system for detailed functional status evaluation.
Importance:
Functional status assessment methods are important as outcome measures for pediatric critical care studies.
Objective:
To investigate the relationships between the 2 functional status assessment methods appropriate for large-sample studies, the Functional Status Scale (FSS) and the Pediatric Overall Performance Category and Pediatric Cerebral Performance Category (POPC/PCPC) scales.
Design, Setting, And Participants:
Prospective cohort study with random patient selection at 7 sites and 8 children's hospitals with general/medical and cardiac/cardiovascular pediatric intensive care units (PICUs) in the Collaborative Pediatric Critical Care Research Network. Participants included all PICU patients younger than 18 years.
Main Outcomes And Measures:
Functional Status Scale and POPC/PCPC scores determined at PICU admission (baseline) and PICU discharge. We investigated the association between the baseline and PICU discharge POPC/PCPC scores and the baseline and PICU discharge FSS scores, the dispersion of FSS scores within each of the POPC/PCPC ratings, and the relationship between the FSS neurologic components (FSS-CNS) and the PCPC.
Results:
We included 5017 patients. We found a significant (P < .001) difference between FSS scores in each POPC or PCPC interval, with an FSS score increase with each worsening POPC/PCPC rating. The FSS scores for the good and mild disability POPC/PCPC ratings were similar and increased by 2 to 3 points for the POPC/PCPC change from mild to moderate disability, 5 to 6 points for moderate to severe disability, and 8 to 9 points for severe disability to vegetative state or coma. The dispersion of FSS scores within each POPC and PCPC rating was substantial and increased with worsening POPC and PCPC scores. We also found a significant (P < .001) difference between the FSS-CNS scores between each of the PCPC ratings with increases in the FSS-CNS score for each higher PCPC rating.
Conclusions And Relevance:
The FSS and POPC/PCPC system are closely associated. Increases in FSS scores occur with each higher POPC and PCPC rating and with greater magnitudes of change as the dysfunction severity increases. However, the dispersion of the FSS scores indicated a lack of precision in the POPC/PCPC system when compared with the more objective and granular FSS. The relationship between the PCPC and the FSS-CNS paralleled the relationship between the FSS and POPC/PCPC system.
