Use of functional status score as a tool to evaluate morbidity and improvement in clinical status on discharge from Pediatric ICU of a tertiary care hospital in Karachi, Pakistan

Abstract

Background: Advances in pediatric intensive care have improved survival rates, yet many critically ill children experience persistent functional impairments post-discharge. The Functional Status Scale (FSS) is a validated tool for assessing functional outcomes in critically ill children, but its utility remains underexplored in Pakistani institutions. This study aimed to evaluate the FSS of pediatric patients at admission and discharge from the intensive care unit (ICU) to determine recovery trends and identify residual morbidity.

Methods: A cross-sectional study was conducted in the pediatric ICU of Civil Hospital Karachi over six months, following institutional review board approval. Using a non-probability consecutive sampling method, 84 children aged 1 to 12 years who were admitted for over 24 hours were included. Exclusion criteria encompassed congenital heart disease, neurological disorders, and ICU mortality. FSS was recorded at admission and discharge, assessing six domains: mental status, sensory functioning, communication, motor functioning, feeding, and respiratory functioning. Statistical analysis was performed using SPSS 26.0, applying paired t-tests, McNemar tests, and chi-square tests, with a significance level of p<0.05.

Results: Among 84 participants (56% female, 44% male), the median age was 3 years (IQR: 2-5). Most admissions were from the emergency department (81%). The median FSS score decreased significantly from 12 (IQR: 10-18) at admission to 6 (IQR: 6-6) at discharge (p<0.001), indicating substantial functional improvement. At admission, 45.2% had moderate dysfunction, 17.9% severe, and 19.0% very severe dysfunction, while only 1.2% had normal function. By discharge, 86.9% had normal function, with severe and very severe dysfunction nearly eliminated. Mechanical ventilation use correlated with higher dysfunction (p=0.026). Patients with CNS disorders had poorer functional recovery. Readmission was required in 16.7% of cases, and prolonged hospitalization was associated with higher readmission rates (p=0.018).

Conclusion: The study demonstrated significant functional recovery among pediatric ICU survivors, highlighting the importance of systematic functional status assessments. The FSS proved valuable in tracking morbidity and guiding early interventions, particularly for patients requiring mechanical ventilation or with CNS-related admissions. These findings support integrating FSS into routine ICU evaluations to enhance long-term patient care and rehabilitation strategies.