Functional Status Scale (FSS) for Pediatric Hospitalization Outcomes: A Tool for Researchers

NICHD-funded research scale helps measure functional status of children during hospital admissions

Measuring children’s outcomes in a consistent and reliable manner can be difficult, especially for large pediatric studies, which enroll children with diverse health problems and ages. Researchers in NICHD’s Collaborative Pediatric Critical Care Research Network (CPCCRN) developed the FSS to more easily and consistently evaluate the functional status of hospitalized children.

Developing the Scale

A team of NICHD-funded researchers developed the FSS to overcome gaps common to existing pediatric outcome measurements, which tend to use death as the primary outcome, are too time-consuming and subjective, or apply to only a limited ages or setting. The FSS is easy and fast to use, minimally subjective, and applicable to a broad age range in a variety of hospital environments.

The study team enrolled 836 pediatric patients and used the Adaptive Behavior Assessment System II to calibrate and then validate the FSS scale. The patients included children admitted to the pediatric intensive care unit (PICU), those not in the PICU but at high risk, and children with chronic diseases who require specialized medical equipment (also called technology-dependent).

The study team included different pediatric health specialists—pediatricians, neurologists, developmental psychologists, physiatrists and rehabilitation specialists, nurses, intensivists and critical care doctors, respiratory therapists—from 11 institutions.

FSS at a Glance

FSS is an objective, rapid, quantitative, and reliable tool to assess functional status in all children from full-term newborns to adolescents. Conceptually, the scale is based on activities of daily living scales, which are used in adult studies to evaluate functioning, disability, and dependency. It is important to note that the FSS is not designed to predict long-term outcomes. Furthermore, the FSS should not be used to assess or predict outcomes for individual pediatric patients.

The FSS examines 6 domains of functioning, and each domain receives a score of 1 (normal), 2 (mild dysfunction), 3 (moderate dysfunction), 4 (severe dysfunction), or 5 (very severe dysfunction). Final scores range from 6 to 30. With training, nurses, therapists, or physicians can collect FSS data.

More Information

  • CPCCRN Website external link
  • Pollack, M. M., Holubkov, R., Glass, P., Dean, J. M., Meert, K. L., Zimmerman, J., Anand, K. J., Carcillo, J., Newth, C. J., Harrison, R., Willson, D. F., Nicholson, C., & Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (2009). Functional status scale: New pediatric outcome measure. Pediatrics, 124(1), e18–e28. PMC: PMC3191069
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