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Minimal Clinically Important Difference of the Functional Status Scale in Pediatric Neurocritical Care Patients: Post
Indar Kumar Sharawat1, Prateek Kumar Panda2, Aman Elwadhi1
1Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
Insights
The Functional Status Scale (FSS) has a minimal clinically important difference (MCID) of 3 points for assessing neurocritical children. This finding helps in better understanding functional impairment changes in pediatric neurocritical care.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Clinical Outcome Measurement
Background:
- The Functional Status Scale (FSS) offers a comprehensive assessment of functional impairment in neurocritical pediatric patients.
- It is considered more multidimensional than the Pediatric Cerebral Performance Category (PCPC) score.
Purpose of the Study:
- To determine the minimal clinically important difference (MCID) for the Functional Status Scale (FSS) in neurocritical children.
- To utilize an anchor-based approach with the PCPC score to establish the FSS MCID.
Main Methods:
- Secondary post hoc analysis of a randomized controlled trial on early rehabilitation in neurocritical children.
- Anchor-based approach using PCPC scores to define improvement (≥1 point reduction) between 12 and 24 weeks.
- Receiver operating characteristic (ROC) curve analysis to identify the optimal FSS change score for MCID.
Main Results:
- Analysis included 188 participants; 125 showed significant improvement based on PCPC.
- The FSS score reduction was significantly greater in the improved group (2.9 ± 0.7) versus the stable/not improved group (1.9 ± 0.5).
- The optimal MCID for FSS was determined to be 3 points, with an AUC of 0.86, sensitivity of 79.2%, and specificity of 87.3%.
Conclusions:
- The minimal clinically important difference (MCID) for the Functional Status Scale (FSS) in this cohort of neurocritical children is 3 points.
- External validation of this FSS MCID is recommended in future research.
Background:
The Functional Status Scale (FSS) is a validated tool that provides a more comprehensive and multidimensional assessment of functional impairment in neurocritical children compared with the Pediatric Cerebral Performance Category (PCPC) score.
Methods:
This study is a secondary post hoc analysis of a randomized controlled trial, which evaluated the efficacy and safety of early protocolized rehabilitation in neurocritical children. An anchor-based approach was used to calculate the minimal clinically important difference (MCID) for FSS, with PCPC serving as the anchor variable. Participants were dichotomized on the basis of PCPC scores into two groups: those who demonstrated improvement between 12 and 24 weeks (defined as a reduction of ≥ 1 point in PCPC score) and those who did not (no change or worsening). Receiver operating characteristic (ROC) curve analysis was performed to identify the optimal FSS change score corresponding to the MCID. Sensitivity, specificity, and Youden's index were calculated.
Results:
Data from 188 participants were analyzed. On the basis of PCPC, 125 participants improved significantly between 12 and 24 weeks. At 24 weeks, the reduction in FSS scores was significantly greater in the improved group compared with the stable/not improved group (2.9 ± 0.7 vs. 1.9 ± 0.5, p < 0.001). The optimal MCID cutoff for FSS was 3 points, with an AUC of 0.86 (95% CI: 0.81-0.91), and sensitivity, specificity, accuracy, and a Youden index of 79.2%, 87.3%, 81.9%, and 0.66, respectively. A total of 26 participants (20%) in the "improved" group were misclassified as "stable/not improved", and 8 participants (12%) in the "stable/not improved" group were misclassified as "improved."
Conclusions:
The minimal clinically important difference (MCID) for the Functional Status Scale (FSS) in our study was determined to be 3 points. This, however, needs to be externally validated in future studies.
