56-Clinician Prediction of Functional Outcomes Following Pediatric Critical Illness
Back to course
Video Transcription
Video Summary
Asset Subtitle
Pediatrics, Quality and Patient Safety, 2021
Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Suzanne Gouda


Introduction/Hypothesis: Clinician prognostication impacts medical decision-making, but the accuracy of predictions of functional outcomes after critical illness is not well studied. We evaluated the accuracy of clinicians' predictions of functional outcomes compared to an objective tool and assessed agreement with parent/guardian perception of their child's functional status.

Methods: A prospective, observational cohort study at an urban, tertiary pediatric intensive care unit (PICU) was performed. Functional Status Scale (FSS) scores were obtained for patients ≤ 18 years old at baseline through electronic health record review. Parents were interviewed to determine child FSS at 6 months and 3 years after discharge. Clinicians were asked to predict the level of functional deficits after discharge. The accuracy of clinicians' predictions compared to FSS scores was assessed. Concordance between parent/guardian perception of their child's functional status, FSS scores, and clinician predictions was also assessed.

Results: One hundred twenty nine patients were enrolled, 77 of these patients had follow-up data available. More than one-third of these children had worsening of their functional status or died by three years after discharge. While more than half of clinicians correctly predicted normal functional status, the accuracy of clinician predictions of mild, moderate, or severe dysfunction compared to FSS scores was poor at both time points, with kappa coefficients <0.25 and positive predictive values (PPV) <20%. Clinician level or training did not correlate with improved accuracy. Parent/guardian perception of their child's functional status poorly aligned with measured FSS scores and clinician predictions with all kappa coefficients <0.25. PPVs of predictions by clinicians compared to parent perceptions was modest (< 45%).

Conclusions: Our findings demonstrate clinicians inaccurately predict long-term dysfunction and that parent/guardian perceptions of functional status differ from both FSS scores and clinician predictions. Clinicians' poor prognostic ability and the lack of alignment with parental perception of functional status complicates the ability to guide families regarding complex medical decision-making in the PICU and long-term outcomes.


Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Quality and Patient Safety
Knowledge Level Advanced
Membership Level Select
Tag Scoring Systems
Year 2021
clinician predictions
functional outcomes
objective functional status scores
parental perceptions
prognostic discussions


Society of Critical Care Medicine

500 Midway Drive
Mount Prospect, IL 60056 USA

Phone: +1 847 827-6888
Fax: +1 847 439-7226
Email: support@sccm.org

Contact Us

About SCCM


Advertising & Sponsorship




Patients & Families

Surviving Sepsis Campaign

Critical Care Societies Collaborative

kisspng-facebook-social-media-computer-icons-linkedin-soci-gray-5ac493cf1c2975.7867418415228323351154  - KW Symphony    Gray twitter 3 icon - Free gray social icons    Gray linkedin 3 icon - Free gray site logo icons    Gray instagram icon - Free gray social icons    YouTube Icon Gray Box - HONOR VETERANS NOW


© Society of Critical Care Medicine. All rights reserved.   |    Privacy Statement    |    Terms & Conditions
The Society of Critical Care Medicine, SCCM, and Critical Care Congress are registered trademarks of the Society of Critical Care Medicine.

Android App Download IOS App Download Powered By