Trauma is different: Redefining abnormal Functional Status Scale values in injured children.

Abstract

The Functional Status Scale has been proposed for assessing functional outcomes after pediatric injury. The Functional Status Scale was developed in critically ill children with a score of 6 defined as normal and Functional Status Scale ≥8 as "abnormal." Previous work using this definition has shown that 51% of injured children with disability at follow-up did not have disability at hospital discharge, suggesting that defining Functional Status Scale ≥8 as "abnormal" may underestimate impairment in children with mild single-system disability (Functional Status Scale = 7). We aimed to determine appropriate classification of Functional Status Scale = 7 in injured children. We hypothesized that a Functional Status Scale = 7 at discharge would (1) correlate with previously established disability measures and (2) have higher rates of long-term disability than those with no disability (Functional Status Scale = 6) at discharge. Data from the "Assessment of Health-Related Quality of Life and Functional Outcomes after Pediatric Trauma" prospective multicenter study were analyzed. Agreement was assessed between Functional Status Scale and Pediatric Overall Performance Category. Detectable disability at 6-month follow-up using Functional Status Scale and Pediatric Overall Performance Category was compared between children with discharge Functional Status Scale of 6, 7, or 8. Data from 427 children with available long-term follow-up were analyzed. Children with Functional Status Scale = 7 had detectable disability by Pediatric Overall Performance Category in 48% (55/114) at discharge and in 50% (20/40) at follow-up. Disability measured by Functional Status Scale and Pediatric Overall Performance Category at follow-up was higher among patients with discharge Functional Status Scale = 7 (26% and 19%) than those with discharge Functional Status Scale = 6 (13% and 3.8%; P ≤ .01). Classifying Functional Status Scale = 7 as "good" underestimates long-term injury-related disability. These findings support obtaining follow-up functional assessments on injured children with Functional Status Scale ≥7 at discharge.