Use of The American Society of Anaesthesiologists Physical Status Classification in non-trauma surgical versus trauma patients: a survey of inter-observer consistency
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 least three different gradings. Scenarios involving trauma, paediatrics, neurosurgery and the airway were associated with greater inconsistency. There was a statistically significant (p < 0.01) difference in inter-rater variability between the trauma and non-trauma scenarios.
Conclusion: The ASA-PS Classification shows poor inter-rater consistency when trauma patients are scored compared to non-trauma patients. Anaesthetists found it an overall inadequate tool to be used perioperatively in its current state. There has been suggestion for a possible multifactorial modification with an aim to improve preoperative physical status and risk assessment of patients.
By submitting manuscripts to SAJAA, authors of original articles are assigning copyright to the SA Society of Anaesthesiologists. Authors may use their own work after publication without written permission, provided they acknowledge the original source. Individuals and academic institutions may freely copy and distribute articles published in SAJAA for educational and research purposes without obtaining permission.
The work is licensed under a Creative Commons Attribution-Non-Commercial Works 4.0 South Africa License. The SAJAA does not hold itself responsible for statements made by the authors.