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

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.