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A Cross-Sectional Study of the Clinical Metrics of Functional Status Tools in Pediatric Critical Illness
Chengsi Ong1,2, Jan Hau Lee3,4, Liying Yang5
1Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Insights
Functional assessment tools for pediatric critical illness survivors show varying clinical metrics. The Pediatric Evaluation of Disability Inventory-Computer Adaptive Test may be more suitable than the Functional Status Scale due to fewer ceiling effects.
Area of Science:
- Pediatric critical care medicine
- Rehabilitation medicine
- Clinical assessment
Background:
- Pediatric intensive care unit (PICU) survivors often experience long-term functional deficits.
- Standardized functional assessments are crucial for monitoring recovery and guiding interventions.
- Understanding the clinical metrics of these tools is essential for accurate evaluation.
Purpose of the Study:
- To evaluate the clinical metrics of functional assessment tools in pediatric critical illness survivors.
- To determine the suitability of different functional assessments for this population.
Main Methods:
- Cross-sectional observational study involving 44 PICU survivors and 52 healthy controls.
- Utilized Pediatric Quality of Life Inventory (PedsQL) 4.0, Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), and Functional Status Scale (FSS).
- Assessed floor/ceiling effects, known-group validity, and convergent validity, including muscle strength via hand grip strength.
Main Results:
- Significant ceiling effects were observed in the FSS (69.2%) and PedsQL physical domain (15.4%) in PICU survivors.
- No significant differences in functional scores were found between children with or without complex chronic conditions or baseline functional impairment.
- Convergent validity was demonstrated between PedsQL physical and PEDI-CAT mobility in survivors (partial r = 0.55).
Conclusions:
- Functional assessment tools exhibit varying clinical utility in pediatric critical illness survivors.
- The PEDI-CAT may be more appropriate than the FSS for this population due to lower ceiling effects.
- A combination of functional assessment tools is likely necessary to comprehensively capture the recovery spectrum in pediatric critical illness.
Objectives:
To determine the clinical metrics of functional assessments in pediatric critical illness survivors.
Design:
Cross-sectional observational study.
Setting:
PICU follow-up clinic.
Patients:
Forty-four PICU survivors 6-12 months post PICU stay, and 52 healthy controls 0-18 years old.
Interventions:
Nil.
Measurements And Main Results:
Function was assessed using the Pediatric Quality of Life Inventory 4.0 generic scales and infant scales, the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test, and the Functional Status Scale. Muscle strength was assessed by hand grip strength in children greater than or equal to 6 years. Clinical metrics assessed included floor and ceiling effects, known-group, and convergent validity. Floor and ceiling effects were present if the participants achieving the worst or best scores exceeded 15%, respectively. Known-group validity was assessed by comparing scores between those with and without complex chronic conditions and abnormal versus good baseline function. Convergent validity was assessed using partial correlation between two tools. Functional Status Scale and Pediatric Quality of Life Inventory physical domain scores showed significant ceiling effects in PICU survivors (69.2% and 15.4%, respectively, achieved the highest possible score). Functional scores were not significantly different between children with or without complex chronic conditions or children with good versus abnormal baseline function. In healthy children, Pediatric Quality of Life Inventory physical correlated moderately with hand grip strength (partial r = 0.66; p < 0.001), whereas Pediatric Quality of Life Inventory psychosocial correlated moderately with Pediatric Evaluation of Disability Inventory-Computer Adaptive Test social/cognitive score (partial r = 0.53; p < 0.001). In PICU survivors, only Pediatric Quality of Life Inventory physical and Pediatric Evaluation of Disability Inventory-Computer Adaptive Test mobility scores were correlated (partial r = 0.55; p < 0.001).
Conclusions:
PICU functional assessment tools have varying clinical metrics. Considering ceiling effects, Pediatric Evaluation of Disability Inventory-Computer Adaptive Test may be more suitable in survivors than Functional Status Scale. Differences in scores between children with or without complex chronic conditions, and with or without baseline functional impairment, were not observed. Functional assessments likely require a combination of tools to measure the spectrum of pediatric critical illness and recovery.
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