Functional evaluation of children on discharge from pediatric intensive care unit using functional status scale
Abstract
Introduction: Despite a reduction in pediatric critical care mortality rates over the past three decades, morbidity among survivors has increased noticeably. The Functional Status Scale (FSS) serves as a crucial tool for evaluating morbidity in these patients. This study aims to assess FSS scores in children upon discharge from the pediatric intensive care unit (PICU) and three months later.
Methodology: A prospective observational study was conducted at Shifa International Hospital from January to June 2023. FSS scores were collected pre-illness, upon admission, discharge, and at a three-month follow-up. Demographics and clinical data were obtained via a predetermined questionnaire.
Results: Of 191 patients, 132 were included, with a median age of 54 months (range: 12-114) and 76 (57%) males. The median PRISM score was 3 (range: 0-7). Acute respiratory illnesses 24(18%) and neuromuscular illnesses 22 (16%) were the most common diagnostic categories. New morbidity incidence between pre-illness and discharge was 24(18%), and between pre-illness and follow-up was 5(3.7%). Children with neuromuscular diseases had significantly higher new morbidity risks at both discharge and follow-up. Length of PICU stay and duration of mechanical ventilation showed significant associations.
Conclusion: The study revealed 18% new morbidity incidence at PICU discharge and 3.7% at 03-month follow-up. Neuromuscular disease patients were notably vulnerable. These findings emphasize the need for ongoing functional assessments and targeted interventions, especially for pediatric ICU survivors with neuromuscular conditions.
Downloads
References
Namachivayam P, Shann F, Shekerdemian L, Taylor A, van Sloten I, Delzoppo C, et al. Three decades of pediatric intensive care: Who was admitted, what happened in intensive care, and what happened afterward. Pediatr Crit Care Med. 2010; 11(5):549-55.
DOI: https://doi.org/10.1097/PCC.0b013e3181ce7427
Jain S, Bhalke S, Srivastava A. A study of morbidity pattern in PICU at the tertiary care center. J Pediat. Cri. Care. 2018; 5(5):23-5.
DOI: https://doi.org/10.21304/2018.0505.00420
Pollack MM, Banks R, Holubkov R, Meert KL, Kennedy E. Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Long-Term Outcome of PICU Patients Discharged With New, Functional Status Morbidity. Pediatr Crit Care Med. 2021; 22(1):27-39.
DOI: https://doi.org/10.1097/PCC.0000000000002590
Heneghan JA, Pollack MM. Morbidity: Changing the Outcome Paradigm for Pediatric Critical Care. Pediatr Clin North Am. 2017; 64(5):1147-65.
DOI: https://doi.org/10.1016/j.pcl.2017.06.011.
Pollack MM, Holubkov R, Glass P, Dean JM. Functional Status Scale: new pediatric outcome measure. Pediatrics. 2009; 124(1):e18-28.
DOI: https://doi.org/10.1542/peds.2008-1987
Pollack MM, Holubkov R, Funai T, Clark A. Pediatric intensive care outcomes: development of new morbidities during pediatric critical care. Pediatr Crit Care Med. 2014; 15(9):821-7
DOI: https://doi.org/10.1542/peds.2008-1987.
Pereira GA, Schaan CW, Ferrari RS. Functional evaluation of pediatric patients after discharge from the intensive care unit using the Functional Status Scale. Rev Bras Ter Intensiva. 2017; 29(4):460-5.
DOI: https://doi.org/10.5935/0103-507X.20170066.
Bennett TD, Dixon RR, Kartchner C, DeWitt PE, Sierra Y, Ladell D, et al. Functional Status Scale in children with traumatic brain injury: A prospective cohort study. Pediatr Crit Care Med. 2016; 17(12):1147-56.
DOI: https://doi.org/10.1097/PCC.0000000000000934.
Cashen K, Reeder R, Dalton HJ, Berg RA. Functional Status of Neonatal and Pediatric Patients After Extracorporeal Membrane Oxygenation. Pediatr Crit Care Med. 2017; 18(6):561-70.
DOI: https://doi.org/10.1097/PCC.0000000000001155.
Eulmesekian PG, Alvarez JP, Ceriani Cernadas JM, Pérez A. The occurrence of adverse events is associated with increased morbidity and mortality in children admitted to a single pediatric intensive care unit. Eur J Pediatr. 2020; 179(3):473-82.
DOI: https://doi.org/10.1007/s00431-019-03528-z.
Wolfe HA, Sutton RM, Reeder RW, Meert KL. Functional outcomes among survivors of pediatric in-hospital cardiac arrest are associated with baseline neurologic and functional status, but not with diastolic blood pressure during CPR. Resuscitation. 2019; 143:57-65
DOI: https://doi.org/10.1016/j.resuscitation.2019.08.006
Haque A, Bhatti S, Ahmed SA, Muhammad I. Incidence of new morbidity based on Functional Status Scale in children on discharge from pediatric intensive care unit of a developing country: A single-center observational study. J Pediatr Crit Care. 2022; 9:165-8.
DOI: https://doi.org/10.4103/jpcc.jpcc_46_22
Álvarez JP, Vázquez EN, Eulmesekian PG. Incidence of morbidity and associated factors in a Pediatric Intensive Care Unit. Arch Argent Pediatr 2021; 119(6):394-400
DOI: https://doi.org/10.5546/aap.2021.eng.394.
Iqbal I, Qazi MF, Shah MA, Abbas A, Abbas Q, ur Rehman N. Incidence of new morbidity in children on discharge from pediatric intensive care unit of a developing country. Professional Med J. 2023; 30(10):1317-23.
DOI: https://doi.org/10.29309/TPMJ/2023.30.10.7687
Peiter D, Schaan W, Campos C, Knisspell De Oliveira C, Rosa V, et al. Functional status and hospital readmission after pediatric critical disease: A year follow-up. Pediatr Crit Care Med. 2022; 23(10):831-5.
DOI: https://doi.org/10.1097/PCC.0000000000003042.
Senna S, Ong C, Wong JJ-M, Allen JC, Sultana R, Lee JH. Prediction of acquired morbidity using illness severity indices in pediatric intensive care patients. Pediatr Crit Care Med. 2020; 21(11):e972-80.
DOI: http://dx.doi.org/10.1097/pcc.0000000000002417
Schunck ED, Schaan CW, Pereira GA, Rosa NV, Normann TC, Ricachinevsky CP, et al. Functional deficit in children with congenital heart disease undergoing surgical correction after intensive care unit discharge. Rev Bras Ter Intensiva. 2020; 32(2).
DOI: http://dx.doi.org/10.5935/0103-507x.20200042
Lau-Braunhut SA, Smith AM, Steurer MA, Murray BL, Sawe H, Matthay MA, Reynolds T, Kortz TB. Functional outcomes and morbidity in pediatric sepsis survivors: a Tanzanian experience. Front Pediatr. 2022; 9:805518.
Copyright (c) 2024 Journal of Shifa Tameer-e-Millat University

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Journal of Shifa Tameer-e-Millat University (JSTMU) is the owner of all copyright to any work published in the journal. Any material printed in JSTMU may not be reproduced without the permission of the editors or publisher. The Journal accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing and/or decision in this journal. The Editorial Board makes every effort to ensure the accuracy and authenticity of material printed in the journal. However, conclusions and statements expressed are views of the authors and do not necessarily reflect the opinions of the Editorial Board or JSTMU.

Content of this journal is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
