The Association Between the Functional Status Scale and the Pediatric Functional Independence Measure in Children Who Survive Traumatic Brain Injury

Objectives: To determine the association between the Functional Status Scale and Pediatric Functional Independence Measure scores during the rehabilitation stay in children who survive traumatic brain injury. Design: Secondary analysis of a prospective observational cohort study. Setting: Tertiary care children’s hospital with a level 1 trauma center and inpatient rehabilitation service. Patients: Sixty-five children less than 18 years old admitted to an ICU with acute traumatic brain injury and subsequently transferred to the inpatient rehabilitation service. Interventions: Not applicable. Measurements and Main Results: Functional Status Scale and Pediatric Functional Independence Measure at transfer to rehabilitation and Pediatric Functional Independence Measure at discharge from rehabilitation. The median age of the cohort was 7.1 years (interquartile range, 0.8–12.3 yr), and 29% were female. Nearly all of the children were healthy prior to the traumatic brain injury: six patients (9.2%) had a baseline Functional Status Scale score greater than 6. At the time of transfer to inpatient rehabilitation, total Functional Status Scale and Pediatric Functional Independence Measure scores had the expected negative correlation due to increasing disability resulting in lower scores in Pediatric Functional Independence Measure and higher scores in Functional Status Scale (r = –0.49; 95% CI, –0.62 to –0.35). Among subjects with less disability as measured by lower total Functional Status Scale scores, we found substantial variability in the total Pediatric Functional Independence Measure scores. In contrast, Pediatric Functional Independence Measure scores were consistently low among subjects with a wide range of higher total Functional Status Scale scores (more disability). Conclusions: Although proprietary and more time-intensive, the Pediatric Functional Independence Measure has advantages relative to the Functional Status Scale for less severely injured patients and task-specific measurements. The Functional Status Scale may have advantages relative to the Pediatric Functional Independence Measure for more severely injured patients. Further investigations are needed to characterize changes in the Functional Status Scale during the rehabilitation stay and after discharge. This work was performed at University of Colorado School of Medicine, Children’s Hospital Colorado, Departments of Pediatric Critical Care Medicine and Physical Medicine and Rehabilitation. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (https://ift.tt/2gIrZ5Y). Supported, in part, by the Eunice Kennedy Shriver National Institute for Child Health and Human Development (grant K23HD074620 to Dr. Bennett). Drs. Maddux’s and Bennett’s institutions received funding from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (grant K23HD074620 to Dr. Bennett), and they received support for article research from the National Institutes of Health. Dr. Bennett’s institution also received funding from the Colorado Department of Public Health. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: aline.maddux@childrenscolorado.org ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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