Assignment of pre-event ASA physical status classification by pre-hospital physicians: a prospective inter-rater reliability study (original) (raw)
Related papers
1999
The ASA PS classification is used worldwide by anesthesia providers to assess the preoperative PS of patients. This score is used in many areas of anesthesia including administrative policy-making, performance evaluations, resource allocation and reimbursement of anesthesia services. In addition, it is cited as a variable in virtually all research related to anesthesia and in many other areas of medical research as well. The purpose of this study was to assess inter-rater reliability among anesthesia providers in assigning ASA scores and discover possible sources of variability. A survey containing four general questions and 10 hypothetical case scenarios was given to 70 anesthesia providers asking them to assign ASA scores and provide rationale for their decisions. All subjects reported using the ASA PS classification routinely with nearly all finding it helpful in their practice. Unfortunately, most of the sample viewed the ASA PS as an anesthetic and surgical risk indicator. Findings demonstrate a lack of inter-rater reliability in assigning ASA PS scores with a range in eight of the scenarios of three to five and in only two of the scenarios a range of two. There were no statistical differences between CRNAs and anesthesiologists or between military and non-military providers. Several sources of variability were identified in this study: smoking, pregnancy, nature of the surgery, potential difficult airway, and acute injury. This classification should not be used for administrative policy determination or for reimbursement of anesthesia services until it is revised by a multidisciplinary taskforce.
2018
Background: The American Society of Anaesthesiologists-Physical Status (ASA-PS) Classification is a grading system for classifying surgical patients based on their comorbid background. Despite numerous benefits, its highly subjective nature has led to marked inconsistency when used. The purpose of this study was to assess consistency when public sector anaesthetists score trauma and non-trauma surgical patients using the Classification.Methods: A three-part questionnaire, with 18 clinical scenarios, was administered to 98 anaesthetists requiring them to grade the scenarios using the Classification and give their opinion on its usage.Results: We received 97 completed questionnaires. Eighty-eight percent of respondents routinely use the Classification. Fifty-two percent had read the Classification within the last six months. Many limitations of the use of the ASA System were identified. There was a lack of consistency in the scoring of the scenarios, with each scenario receiving at le...
Annals of Surgery, 2006
The purpose of this study was to determine the relationship between the American Society of Anesthesiologists' Physical Status (ASA PS) classifications and the other National Surgical Quality Improvement Program (NSQIP) preoperative risk factors. Background: The ASA PS has been shown to predict morbidity and mortality in surgical patients but is inconsistently applied and clinically imprecise. It is desirable to have a method for validating ASA PS classification levels. Methods: The NSQIP preoperative risk factors, including ASA PS, were recorded from a random sample of 5878 surgical patients on 6 services between October 1, 2001 and September 30, 2003 at the University of Kentucky Medical Center. Mortality, morbidity, costs, and length of stay were obtained and compared across ASA PS levels. The ability of 1) ASA PS alone, 2) the other NSQIP risk factors, and, 3) all factors combined to predict outcomes was analyzed. A model using the other NSQIP risk factors was developed to predict ASA PS. Results: ASA PS alone was a strong predictor of outcomes (P Ͻ 0.01). However, the other NSQIP risk factors were better predictors as a group. There was significant interdependence between the ASA PS and the other NSQIP risk factors. Predictions of ASA PS using the other factors showed strong agreement with the anesthesiologists' assignments. Conclusions: The NSQIP risk factors other than ASA PS can and should be used to validate ASA PS classifications.
Tạp chí Y Dược học Cần Thơ
Background: ASA classification has been applied all over the world in premedication. The 2019 Amended ASA-PS was modified by new definitions, approved examples, especially definition for emergent patients. In Vietnam, there has not any independent study on ASA- PS classification up to now. The addition of “E” denotes emergency surgery. Objectives: To determine the ratio of patients in each ASA class, their underlying diseases and complications that might happen intraoperative as well as postoperative. Materials and methods: This cross-sectional descriptive study was conducted at Anesthesiology Department of Can Tho University of Medicine and Pharmacy Hospital from January 2021 to December 2021, the sample size was ≥ 420, and the sampling method was convenience sampling. The sample included 528 patients of both emergent and elective operations included. Results: The ratios of ASA were I (39.21%), II (33.52%), III (17.42%), IE (6.06%), IIE (3.03%) and IIIE (0.76%). None of the cases ...
European Geriatric Medicine
Purpose Many methods for preoperative risk stratifications used in everyday practice do not take into account all of the comorbidities and complex physiological status of older patients. Therefore, anaesthesiologists and surgeons must consider multiple ways of preoperative diagnostics. Determining which of the preoperative clinical risk scores [Revised Lee score, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator and Surgical Outcome Risk Tool (SORT)] best improves routinely used American Society of Anaesthesiologists (ASA) physical status classification. Methods The prospective pilot study included 78 patients who were being prepared for extensive non-cardiac surgeries under general anaesthesia. Preoperatively, anaesthesiologist determined ASA score according to guidelines. Then, the data of patients have been processed on the interactive calculators of Revised Lee score, ACS NSQIP and SORT. Results Mean age of included patients was 71.4 ± 6.9 years. When it comes to postoperative mortality prediction, three risk scores (ASA, ACS NSQIP and SORT) have been statistically significant, respectively, P = 0.016, P \ 0.0001, P \ 0.0001. Results showed that AUC being higher in ACS NSQIP and SORT (0.813; 0.797). Out of all three additional risk scores, ACS NSQIP showed to add the most to the specificity and sensitivity of ASA score, with combined AUC = 0.841. Conclusions ACS NSQIP and SORT increase the accuracy of ASA score. Revised Lee score cannot be considered a good indicator of postoperative mortality risk since it is primarily the score which indicates risk for cardiovascular complications. Further studies, with a greater number of patients, are needed. Keywords Care Á Preoperative Á Mortality Á In Hospital Á ACS-NSQIP Á ASA Á SORT Background Preoperative risk assessment is of major importance in clinical practice since about 30% of patients are subjected to extensive surgical procedures in the presence of cardiovascular comorbidities. Worldwide, these types of operations are associated with the level of mortality between 0.8 and 1.5%. About 42% of these events are caused by cardiovascular complications [1].
Risk scoring systems for adults admitted to the emergency department: a systematic review
2010
Background: Patients referred to a medical admission unit (MAU) represent a broad spectrum of disease severity. In the interest of allocating resources to those who might potentially benefit most from clinical interventions, several scoring systems have been proposed as a triaging tool. Even though most scoring systems are not meant to be used on an individual level, they can support the more inexperienced doctors and nurses in assessing the risk of deterioration of their patients. We therefore performed a systematic review on the level of evidence of literature on scoring systems developed or validated in the MAU. We hypothesized that existing scoring systems would have a low level of evidence and only few systems would have been externally validated.
American Society of Anaesthesiologists physical status classification
Indian Journal of Anaesthesia, 2011
Although the American Society of Anaesthesiologists' (ASA) classification of Physical Health is a widely used grading system for preoperative health of the surgical patients, multiple variations were observed between individual anaesthetist's assessments when describing common clinical problems. This article reviews the current knowledge and evaluation regarding ASA Classification of Physical Health as well as trials for possible modification.