Functional Capacity Index
The Functional Capacity Index is a measurement system for the extent of functional limitation or disability that can usually be expected after an injury has healed. It must not be confused with the degree of disability (GdB) of the German law for severely disabled people .
Original definition
The FCI should describe the limitations that can normally still be expected in patients with a certain injury pattern after one year. The focus was not on a single injury, but on the entirety of the individual injuries sustained in an accident. The basis for the classification of the FCI expression is a 10-dimensional consideration of the possible restrictions after completion of an optimal medical treatment. Food intake, excretions, sexual functions, possibilities of movement, bending and lifting, function of the hands, visual perception , acoustic perception , language and cognitive understanding are considered . The degree of restriction is set on a 5-point scale for each dimension.
Single injury based approach
Problem of the original approach
The holistic approach, i.e. the attempt to describe all individual injuries with a measure, led to the same problems at the FCI as they had already occurred over 40 years earlier when describing injuries (see Abbreviated Injury Scale (AIS) ): Due to the large number of variations in the injury pattern the sample size becomes so small in each individual case that no generally valid statements can be derived. This problem was achieved when describing the probability of survival of injuries by breaking down injury pictures into individual injuries.
Development of the individual injury-based approach
In accordance with the procedure in AIS development, FCIs were determined for the individual violations (AIS98 identifier) described in the AIS 1990 update 1998 (AIS98 for short). For this purpose, the individual injuries were presented to a group of experts who were supposed to establish a consensus on the probable degree of 'functional limitation' (predicted FCI, pFCI) on the basis of the 10 dimensions outlined above.
The problem lies in the aggregation of the pFCI values of the individual injuries to the injury patterns found in practice from several individual injuries. For injuries within an ISS body region (with the exception of the extremities), a comparison was possible due to the formation of a maximum. A comparison of different body regions, however, led to implausible results: the description of the anatomical structures in AIS98 is geared towards determining the probability of survival of the injury, a consideration of the functional impairment after completion of the treatment was not part of the AIS up to that point. With the AIS2005, not only the characteristics (AIS codes) were adapted to the current state of treatment and knowledge, the describable anatomical structures were expanded with a view to the FCI and individual injuries were combined into FCI-relevant injury groups. This applies in particular to the extremities and the injuries to the brain as well as to the formation of groups in the case of thoracic injuries. Since the consensus regarding the FCI values for the individual injuries of the AIS2005 could not be achieved quickly enough, the AIS2008 is the first AIS codebook with FCI values for the individual injuries.
Implementation in the AIS2008 Codebook
To simplify the FCI coding, the AIS2005 identifier in the AIS2008 codebook has already been provided with the corresponding version of the FCI. The estimators pFCI determined by the experts were grouped into 5 expression classes and referred to as FCI. Class 5 denotes the lack of a measurable functional restriction, whereas a value of 1 indicates the maximum restriction due to the violation. All injuries with an AIS2008 code of 6 (according to the current state of medicine, non-treatable injury) receive an FCI of 1 (maximum restriction), injuries with an AIS2008 code of 9 cannot be assigned to an FCI characteristic due to the imprecise specification. It should be noted that the order of the grouping of the characteristics of the FCI is exactly the opposite of that of the AIS.
| FCI score | Functional restriction | Functional restriction | Number of FCI coded AIS2008 codes |
|---|---|---|---|
| 5 | Perfect State | No | 1279 |
| 4th | Moderate state | Low | 194 |
| 3 | Serious State | Seriously | 136 |
| 2 | Severe State | Serious | 131 |
| 1 | Worst possible state | Very serious | 156 |
The difference between an evaluation according to FCI and AIS2008 can be seen in the following table. At least some of those classified as 'minor injuries' under the AIS2008 (AIS2008 code = 1, 2, 3) have serious and very serious long-term consequences (FCI = 1, 2):
| AIS2008 code | |||||||
|---|---|---|---|---|---|---|---|
| FCI score | 1 | 2 | 3 | 4th | 5 | 6th | 9 |
| 5 | 357 | 501 | 391 | 79 | 49 | 1 | 1 |
| 4th | 43 | 111 | 36 | 1 | 3 | 0 | 0 |
| 3 | 34 | 62 | 23 | 12 | 5 | 0 | 0 |
| 2 | 4th | 45 | 36 | 28 | 17th | 1 | 0 |
| 1 | 0 | 2 | 16 | 40 | 70 | 28 | 0 |
Aggregation problem
Since the assessment of injuries by the FCI in accordance with the AIS code assessment is based on the AIS identifiers, i.e. the assessment of individual injuries, there is a similar problem of injury severity aggregation. Within a body region or at least one functional group, the minimum formation (minFCI), i.e. the setting of the most serious restriction for the restriction of the body region, is still acceptable. If these limits are exceeded, the functional limitation can be significantly higher than the value calculated using minFCI due to the lack of compensation options. Corresponding aggregation problems already occurred with the FCI coupled to the AIS90 identifier.
Individual evidence
- ↑ a b c d Ellen J. MacKenzie, Anne Damiano, Ted Miller, Steve Luchter: The development of the Functional Capacity Index (FCI) . In: The Journal of Trauma . tape 41 , no. 5 . Williams & Wilkins, November 1996, pp. 799-807 ( jtrauma.com [accessed April 20, 2009]).
- ↑ Abbreviated Injury Scale 1990 Revision Update 1998 . Association for the Advancement of Automotive Medicine (AAAM), Barrington, IL 1998.
- ^ A b Philip J. Schluter, CM Cameron, DM Purdie, EV Kliewer, RJ McClure: How well do anatomical-based injury severity scores predict health service use in the 12 months after injury? In: International Journal of Injury Control and Safety Promotion . tape 12 , no. 4 . Taylor & Francis, December 2005, ISSN 1745-7300 , pp. 241-246 , doi : 10.1080 / 17457300500172735 .
- Jump up ↑ Philip J. Schluter, Rachel Neale, Deborah Scott, Stephen Luchter, Roderick J. McClure: Validating the Functional Capacity Index . A Comparison of Predicted versus Observed Total Body Scores. In: The Journal of Trauma . tape 58 , no. 2 . Lippincott Williams & Wilkins, February 2005, ISSN 0022-5282 , pp. 259-263 ( journals.lww.com [accessed August 15, 2011]).
- ↑ Thomas A. Gennarelli, Elaine Wodzin (Ed.): Abbreviated Injury Scale 2005 . Association for the Advancement of Automotive Medicine (AAAM), Barrington, IL 2005.
- ↑ a b c Thomas A. Gennarelli, Elaine Wodzin (Ed.): Abbreviated Injury Scale 2005 Update 2008 . Association for the Advancement of Automotive Medicine (AAAM), Barrington, IL 2008.