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Performance of a Provider-Assigned Functional Outcome Score in Critically Ill Children
Natalie E Wilson1, Felice Su2,3, Allie DaCar2
1Department of Pediatrics - Critical Care Medicine, University of Rochester, Golisano Children's Hospital, Rochester, NY.
Insights
Pediatric Cerebral Performance Category (PCPC) scores integrated into clinical workflow show excellent agreement with investigator-assigned scores. This demonstrates successful integration of cognitive functional status measurement into daily provider workflow.
Area of Science:
- Pediatric critical care medicine
- Neurodevelopmental outcomes
- Clinical informatics
Background:
- Assessing cognitive functional status in pediatric intensive care unit (PICU) patients is crucial.
- Traditional methods often rely on retrospective chart review, which can be time-consuming.
- Integrating functional assessments into routine clinical workflow offers potential benefits for efficiency and data collection.
Purpose of the Study:
- To determine the agreement between Pediatric Cerebral Performance Category (PCPC) scores assigned during routine clinical workflow and those assigned by investigators via retrospective chart review.
- To evaluate the feasibility and concordance of using PCPC scores as a standard of care in the PICU.
Main Methods:
- A longitudinal study was conducted at a single-center academic institution.
- Children admitted to the PICU between November 2019 and April 2020 were included.
- Providers assigned PCPC scores during daily workflow, while investigators assigned scores retrospectively.
Main Results:
- Of 782 surviving patients, admission and discharge PCPC scores were recorded in 95% and 90%, respectively.
- Excellent agreement was observed between provider- and investigator-assigned scores, with weighted kappas of 0.87 for admission and 0.80 for discharge.
- These findings support the reliability of workflow-integrated PCPC scoring.
Conclusions:
- Provider-assigned PCPC scores, when integrated into standard clinical workflow, are highly concordant with retrospective investigator assessments.
- The successful integration of PCPC scoring into daily workflow facilitates the measurement of cognitive functional status.
- This approach is valuable for clinical care, quality improvement initiatives, and research in pediatric critical care settings.
Objectives:
Determine agreement between Pediatric Cerebral Performance Category (PCPC) scores integrated into clinical workflow and traditional investigator-assigned scores.
Design:
Longitudinal study.
Setting:
A single-center quaternary-care academic institution.
Subjects:
Children admitted to the PICU between November 2019 and April 2020.
Interventions:
Providers assigned PCPC scores as part of daily workflow. Investigators assigned scores using retrospective chart review.
Measurements And Main Results:
Of 803 patients admitted to the PICU, 782 survived and were included. Admission and discharge scores were recorded in 95% and 90% of patients, respectively. Agreement between provider- and investigator-assigned scores was excellent, with a weighted kappa of 0.87 (95% CI, 0.84-0.90) and 0.80 (95% CI, 0.76-0.84) for admission and discharge.
Conclusions:
Provider-assigned PCPC scores, documented as standard of care, are largely concordant with retrospective investigator-assigned scores. Measurement of cognitive functional status can be successfully integrated into daily provider workflow for use in the clinical, quality improvement, and research arenas.
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