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Functional Status Scale as a Measure of Functional Impairment and Residual Morbidity in Pediatric Intensive Care Unit
Nupur Bajpai1, Kunal C Dubey2, Satyabrata R Chowdhoury3
1Department of Pediatrics, North Bengal Medical College and Hospital, Siliguri, West Bengal, India.
Insights
Pediatric intensive care unit (PICU) survivors experienced increased functional impairment at discharge, but this improved by 3 months. The Functional Status Scale (FSS) effectively measured this residual morbidity in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Functional assessment in children
- Post-intensive care syndrome
Background:
- Limited data exist on functional impairments in pediatric intensive care unit (PICU) survivors.
- Growing clinical interest in acquired functional morbidity among these patients.
- The Functional Status Scale (FSS) is a validated tool for assessing functional impairments.
Purpose of the Study:
- To assess changes in functional status of PICU survivors at discharge and 3-month follow-up compared to baseline.
- To identify residual morbidity at 3 months post-PICU discharge.
- To evaluate the effectiveness of the FSS in measuring functional changes.
Main Methods:
- Inclusion of children aged 2 months to 12 years with a PICU stay ≥48 hours or age-adjusted quick sequential organ failure assessment (qSOFA) score ≤2.
- Functional assessment using the FSS at PICU admission, during PICU stay, at discharge, and at 3-month follow-up.
- Observational study at a single center.
Main Results:
- 3.3% of patients exhibited residual morbidity (≥1 FSS increase) at 3-month follow-up.
- PICU survivors showed greater functional impairment at discharge versus baseline (p < 0.01), which resolved by 3 months (p = 0.09).
- Neurological causes for PICU admission (p = 0.007) and mechanical ventilation (p = 0.019) were associated with significant differences. Longer PICU stays correlated with greater discharge functional impairment (p = 0.04).
Conclusions:
- The FSS is effective for evaluating functional impairments in PICU patients.
- Functional impairments in PICU survivors are influenced by factors like length of stay, reason for admission, and treatment modalities.
- Most pediatric PICU survivors achieve functional recovery within 3 months, but specific factors indicate higher risk for persistent impairment.
Background And Aims:
Limited data are available on the functional impairments of critically ill patients who survive the pediatric intensive care unit (PICU). There is rising interest among clinicians and intensivists in newly acquired functional morbidity among such survivors. The Functional Status Scale (FSS) is an effective tool for assessing functional impairments. Our aim was to assess changes in the functional status of patients at discharge from the PICU and at a 3-month follow-up compared to baseline. We also intended to observe for any residual morbidity at 3 months after discharge from the PICU.
Patients And Methods:
Children aged 2 months to 12 years with a PICU stay of 48 hours or more, or an age-adjusted quick sequential organ failure assessment (qSOFA) score of 2 or less, were included in the study. Functional assessment using the FSS was performed for these patients at PICU admission, during the PICU stay, at discharge from the PICU, and at the 3-month follow-up.
Results:
We observed that 3.3% of patients had residual morbidity (≥1 increase in FSS scores from baseline) at the 3-month follow-up. Greater functional impairment was noted in the PICU cohort at discharge compared to baseline (p < 0.01) but not at 3 months (p = 0.09). A statistically significant difference was noted in PICU patients shifted for neurological causes (p = 0.007) and those receiving mechanical ventilation (p = 0.019). The score difference at discharge from baseline was more in patients with longer PICU stays (1.5 ± 0.5; p = 0.04).
Conclusion:
The FSS is an effective tool to evaluate functional impairments among pediatric patients admitted in PICU. Multiple factors, including length of PICU stay, cause of shifting, and modalities of treatment, influence functional impairments.
How To Cite This Article:
Bajpai N, Dubey KC, Chowdhoury SR, Nandi M, Irene M. Functional Status Scale as a Measure of Functional Impairment and Residual Morbidity in Pediatric Intensive Care Unit Survivors: A Single-center Observational Study. Indian J Crit Care Med 2026;30(3):225-230.
