Feasibility of implementation of an age-based guideline for PCPC scoring
Abstract number :
1.15
Submission category :
2. Translational Research / 2A. Human Studies
Year :
2025
Submission ID :
320
Source :
www.aesnet.org
Presentation date :
12/6/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Archana Nelliot, MD – Johns Hopkins School of Medicine
Ajay Thomas, MD, PhD – Baylor College of Medicine/Texas Children's Hospital
Raquel Farias-Moeller, MD – Medical College Wisconsin
Stuart Tomko, MD – Washington University
Anuj Jayakar, MD – Nicklaus Children's Hospital
Brian Appavu, MD – Barrow Neurological Institute at Phoenix Children's Hospital
Dana Harrar, MD, PhD – Center for Neuroscience and Behavioral Health, Children's National Hospital, George Washington University
Lindsey Morgan, MD – Seattle Childrens Hospital
Carlos Castillo-Pinto, MD – Seattle Childrens
Darshana Parikh, BS – University of Pennsylvania - Children's Hospital of Philadelphia
Stephanie Rau, BS, CCRP – University of Michigan School of Medicine
Maelyn Fulton, BS – University of Michigan
Craig Press, MD, PhD, FCNS – Children's Hospital of Philadelphia
Benedetti Giulia, MD – University of Michigan School of Medicine
Rationale: The Pediatric Cerebral Performance Category (PCPC) scale is a 6-point scale, widely used in pediatric research to quantify functional brain-specific impairments after critical illness. PCPC is the most commonly assigned retrospective outcome measure in pediatric critical care research (Capralola et al, 2017) which is comprised of at least 50% infants and young children (Killien et al, 2023). Since published guidance for PCPC scoring focuses primarily on school-aged cognitive outcomes, there is a lack of standardized, developmentally appropriate guidance for infants and young children, which leads to different interpretations of PCPC definitions, and inconsistent scoring among researchers with different levels of medical expertise and training. This variability in data collection impacts analysis and interpretation of outcomes.
Methods: A detailed age-based PCPC scoring guideline was developed to assign level of disability (1-normal, 2-mild disability, 3-moderate disability, 4-severe disability, 5-coma or vegetative state, and 6-brain death) using published AAP developmental milestones and expected neurologic sequelae of injury for the following age groups: 1 month, 3 months, 6 months, 1 year, 2 years, 3 years, 4-5 years, 6-12 years, and > 12 years. These descriptions were reviewed, modified, and consensus approved by 9 site PIs with expertise in pediatric neurocritical care for the Pediatric Quantitative EEG Strategic Taskforce (PedQuEST) Infrastructure study. PCPC disability scores were assigned by retrospective chart review for 52 PedQuEST study subjects at the University of Michigan at the following timepoints: pre-cardiac arrest (CA) baseline, ICU discharge, Hospital Discharge, 30 days post-CA, 1-6 months post-CA and 7-12 months post-CA. Inter-rater agreement and reliability were calculated for the scores assigned by a clinical research coordinator and board-certified attending pediatric neurologist for PCPC disability groups 2 to 5.
Results: 294 PCPC scores out of a possible 312 scores were successfully assigned. 109 (37%) scores were assigned by both reviewers. Percent agreement and weighted kappa values for available timepoints are reported in Table 1. Overall inter-rater agreement and kappa were 99% and 0.93 for available scores.
Conclusions: Implementation of an age-based guideline for scoring of the PCPC was feasible and associated with excellent agreement and interrater reliability, improved from previous reports of agreement between providers and researchers (Wilson et al, 2023). Additional clarity and standardization in these research methods will also improve interpretation of reported outcomes.
Funding: The Pediatric Epilepsy Research Foundation funded this work through their Grant for Infrastructure for the study entitled Pediatric Quantitative EEG Strategic Taskforce (PedQuEST) – Developing a Multicenter Research Collaborative for the Advancement of Quantitative EEG in Pediatric Critical Care.
Translational Research