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Original Investigation |

Relationship Between the Functional Status Scale and the Pediatric Overall Performance Category and Pediatric Cerebral Performance Category Scales

Murray M. Pollack, MD1,2; Richard Holubkov, PhD3; Tomohiko Funai, MS3; Amy Clark, MS3; Frank Moler, MD4; Thomas Shanley, MD4; Kathy Meert, MD5; Christopher J. L. Newth, MD, FRCPC6; Joseph Carcillo, MD7; John T. Berger, MD8; Allan Doctor, MD9,10; Robert A. Berg, MD11; Heidi Dalton, MD1,2; David L. Wessel, MD8; Rick E. Harrison, MD12; J. Michael Dean, MD3; Tammara L. Jenkins, MSN, RN13
[+] Author Affiliations
1Department of Critical Care Medicine, Phoenix Children’s Hospital, Phoenix, Arizona
2Department of Child Health, University of Arizona College of Medicine–Phoenix
3Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
4Department of Pediatrics, University of Michigan, Ann Arbor
5Department of Pediatrics, Children’s Hospital of Michigan, Detroit
6Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, California
7Department of Critical Care Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
8Department of Pediatrics, Children’s National Medical Center, Washington, DC
9Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
10Department of Biochemistry, Washington University School of Medicine, St Louis, Missouri
11Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
12Department of Pediatrics, University of California, Los Angeles
13Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
JAMA Pediatr. 2014;168(7):671-676. doi:10.1001/jamapediatrics.2013.5316.
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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.

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Figure.
Baseline Functional Status Scale (FSS) Scores in Each Pediatric Overall Performance Category (POPC) Rating

The vertical axes show the percentages of patients with the indicated FSS score for each POPC rating. Table 1 shows the total number of patients in each POPC rating. POPC ratings include good (A), mild disability (B), moderate disability (C), severe disability (D), and vegetative state or coma (E). Overall possible FSS scores range from 6 to 30; separate scores range from 1 (normal) to 5 (very severe dysfunction) in each of 6 FSS domains (mental status, sensory, communication, motor function, feeding, and respiratory).

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