Functional evaluation of pediatric patients after discharge from the intensive care unit using the Functional Status Scale

Abstract

ObjectiveTo evaluate the functional status of pediatric patients after discharge from the pediatric intensive care unit using the Functional Status Scale and to compare the time of invasive mechanical ventilation, length of stay in the pediatric intensive care unit, and Pediatric Index of Mortality 2 results among individuals with different degrees of functional impairment.MethodsA cross-sectional study was conducted on patients who were discharged from a pediatric intensive care unit. The functional evaluation by the Functional Status Scale was performed on the first day after discharge from the unit, and the Pediatric Index of Mortality 2 was used to predict the mortality rate at the time of admission to the pediatric intensive care unit.ResultsThe sample consisted of 50 individuals, 60% of which were male, with a median age of 19 [6 - 61] months. The overall score of the Functional Status Scale was 11.5 [7 - 15], and the highest scores were observed in the "motor function" 3 [1 - 4] and "feeding" 4 [1 - 4] domains. Compared to patients who were not readmitted to the pediatric intensive care unit, patients who were readmitted presented a worse overall score (p = 0.01), worse scores in the "motor function" (p = 0.01), "feeding" (p = 0.02), and "respiratory" (p = 0.036) domains, and a higher mortality rate according to the Pediatric Index of Mortality 2 (p = 0.025).ConclusionEvaluation of the functional status using the Functional Status Scale indicated moderate impairment in patients after discharge from the pediatric intensive care unit, mainly in the "motor function" and "feeding" domains; patients who were readmitted to the pediatric intensive care unit demonstrated worse overall functional, motor function, feeding and respiratory scores. Individuals with greater functional impairment had longer times of invasive mechanical ventilation and hospitalization in the pediatric intensive care unit.

Functional deficit in children with congenital heart disease undergoing surgical correction after intensive care unit discharge

“…( 18 ) For the present study, the outcome was analyzed in two distinct ways: we first grouped the scores into levels of dysfunction, i.e., no dysfunction (6 - 7), mild dysfunction (8 - 9), moderate dysfunction (10 - 15), severe dysfunction (16 - 21) and very severe dysfunction (> 21), a classification method used in previous studies. ( 14 , 15 ) Secondly, we dichotomized functional status into adequate function/mild dysfunction and moderate/severe dysfunction.…”

“…Interventions performed during hospitalization ( 12 - 14 ) can cause deficits in the overall functional status of children. ( 3 , 14 - 16 ) Studies have shown that functional decline is directly influenced by clinical variables ( 3 , 17 ) and by risks inherent to the medical intervention and the underlying disease. ( 15 )…”

“…( 18 ) The FSS was recently validated for the Portuguese language, ( 19 ) and recent studies using this scale have shown functional decline after discharge from the pediatric ICU, with a prevalence ranging from 4.6% ( 17 ) to 82%. ( 14 ) Factors such as age, primary dysfunctional system, length of hospital stay and duration of IMV have a direct influence on the onset of deficits. ( 14 , 15 , 17 )…”

“…( 14 ) Factors such as age, primary dysfunctional system, length of hospital stay and duration of IMV have a direct influence on the onset of deficits. ( 14 , 15 , 17 )…”

“…Studies of functional outcomes after pediatric ICU stay have gained prominence recently, but they have include patients with a wide range of illnesses. ( 20 - 22 ) In Brazil, studies on functional deficits in specific illnesses are scarce, ( 14 ) making it difficult to identify potential risk groups and factors that may be associated with worsened functional status after discharge from the pediatric ICU.…”