Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. e18-e28 (doi:10.1542/peds.2008-1987)

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ARTICLE

Functional Status Scale: New Pediatric Outcome Measure

Murray M. Pollack, MD^a, Richard Holubkov, PhD^b, Penny Glass, PhD^a, J. Michael Dean, MD^b, Kathleen L. Meert, MD^c, Jerry Zimmerman, MD, PhD^d, Kanwaljeet J. S. Anand, MBBS, DPhil^e, Joseph Carcillo, MD^f, Christopher J. L. Newth, MB, ChB^g, Rick Harrison, MD^h, Douglas F. Willson, MDⁱ, Carol Nicholson, MD^j and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network

^a Department of Pediatrics, Children's National Medical Center, Washington, DC
^b Department of Pediatrics, University of Utah, Salt Lake City, Utah
^c Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
^d Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
^e Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas
^f Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
^g Department of Pediatrics, Childrens Hospital Los Angeles, Los Angeles, California
^h Department of Pediatrics, University of California, Los Angeles, California
ⁱ Department of Pediatrics, University of Virginia Children's Hospital, Charlottesville, Virginia
^j Department of Pediatrics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland

OBJECTIVE: The goal was to create a functional status outcome measure for large outcome studies that is well defined, quantitative, rapid, reliable, minimally dependent on subjective assessments, and applicable to hospitalized pediatric patients across a wide range of ages and inpatient environments.

METHODS: Functional Status Scale (FSS) domains of functioning included mental status, sensory functioning, communication, motor functioning, feeding, and respiratory status, categorized from normal (score = 1) to very severe dysfunction (score = 5). The Adaptive Behavior Assessment System II (ABAS II) established construct validity and calibration within domains. Seven institutions provided PICU patients within 24 hours before or after PICU discharge, high-risk non-PICU patients within 24 hours after admission, and technology-dependent children. Primary care nurses completed the ABAS II. Statistical analyses were performed.

RESULTS: A total of 836 children, with a mean FSS score of 10.3 (SD: 4.4), were studied. Eighteen percent had the minimal possible FSS score of 6, 44% had FSS scores of 10, 14% had FSS scores of 15, and 6% had FSS scores of 20. Each FSS domain was associated with mean ABAS II scores (P < .0001). Cells in each domain were collapsed and reweighted, which improved correlations with ABAS II scores (P < .001 for improvements). Discrimination was very good for moderate and severe dysfunction (ABAS II categories) and improved with FSS weighting. Intraclass correlations of original and weighted total FSS scores were 0.95 and 0.94, respectively.

CONCLUSIONS: The FSS met our objectives and is well suited for large outcome studies.

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Key Words: functional status • outcome assessment • activities of daily living • adaptive behavior • health status indicators • health utilities index • treatment outcome • child

Abbreviations: FSS—Functional Status Scale • ABAS II—Adaptive Behavior Assessment System II • ROC—receiver operating characteristic

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