The Cognitive Status Scale: A Preliminary Investigation of Psychometric Properties in a Clinically Referred Pediatric Critical Care Sample.

BACKGROUND

Cognitive morbidities persist after pediatric critical care. However, a significant gap exists related to measuring cognitive outcomes in this patient population due to heterogeneity in presentations and objective measures. This study's purpose was to develop a psychometrically sound coding system to summarize clinically generated and performance-based neuropsychological outcomes to be used for research.

METHODS

The work was conducted in two stages: (1) Cognitive Status Scale (CSS) development and (2) a retrospective pilot test in a clinically referred sample of post-critical-care youth aged 6-19 years (N = 110) to explore preliminary psychometric properties of the CSS.

RESULTS

Principal components analysis supported the CSS structure (capturing 59% of the total explained variance). Internal consistency (α = 0.82) and interrater reliability (r = 0.92) were good. Within the full sample, criterion-related validity was demonstrated as the CSS total composite score from long-term evaluation and was significantly correlated with abbreviated performance-based cognitive outcomes from the acute recovery phase (Neurocognitive Index, r = 0.74). Divergent validity was shown via significant differences on the CSS total composite score between known clinical groups (≥ 3 Functional Status Scale [FFS] change = 30.23 vs. ≤ 2 FFS change = 50.94, t = 4.10, p ≤ 0.001, d = 0.91) and across CSS clinical indicators (F = 8.4495, p =  < 0.001, η = 0.194). Bivariate correlations showed a significant association in the expected direction between the CSS total composite score and the Functional Status Scale total score (r =  - 0.44, p ≤ 0.001), as well as a significant association in the expected direction between the CSS total composite score and the Behavior Rating Inventory of Executive Function, Second Edition General Executive Composite (r =  - 0.29, p = 0.010).

CONCLUSIONS

Primary evidence shows the CSS to be a reliable and valid measure for summarizing a clinically administered battery of cognitive assessments. Easy-to-generate metrics of performance-based cognition are essential to progress the state of the science germane to cognitive outcomes post pediatric critical care.