The ASA Physical Status Classification: Inter-observer Consistency

The American Society of Anesthesiologists (ASA) physical status classification system has previously been shown to be inconsistently applied by anaesthetists. One hundred and sixty questionnaires were sent out to all specialist anaesthetists in Hong Kong. Ten hypothetical patients, identical to those of a similar study undertaken 20 years ago, each with different types and degrees of physical disability were described. Respondents were asked about their country of training and type of anaesthetic practice and to assign an ASA classification status for each patient. Ninety-seven questionnaires were returned (61%) after two mailings. Agreement for each patient within groups, between groups and overall comparisons were made. Percentage of agreement was between 31 to 85%. Overall correlation was only fair in all groups (Kappa indices: 0.21–0.4). We found that the current pattern of inter-observer inconsistency of classification was similar to that 20 years ago and exaggerated between locally and overseas trained specialists (P<0.05). The validity of the ASA system, its usefulness and the need for a new, more precise scoring system is discussed.

[1]  R. Dripps,et al.  The role of anesthesia in surgical mortality. , 1961, JAMA.

[2]  J. Little Consistency of ASA grading. , 1995, Anaesthesia.

[3]  T McDonald,et al.  Hospital Costs and Severity of Illness in Three Types of Elective Surgery , 1997, Anesthesiology.

[4]  E Magi,et al.  ASA classification and perioperative variables as predictors of postoperative outcome. , 1997, British journal of anaesthesia.

[5]  D. Candinas,et al.  Preoperative risk assessment in elective general surgery , 1996, The British journal of surgery.

[6]  H. Haljamäe Anesthetic risk factors. , 1989, Acta chirurgica Scandinavica. Supplementum.

[7]  K. Yamaguchi,et al.  ASA physical status and age are not factors predicting morbidity, mortality, and survival after pancreatoduodenectomy. , 1996, The American surgeon.

[8]  G. Sigurdsson,et al.  Morbidity and mortality associated with anaesthesia , 1996, Acta anaesthesiologica Scandinavica.

[9]  T. Pedersen,et al.  A prospective study of mortality associated with anaesthesia and surgery: risk indicators of mortality in hospital , 1990, Acta anaesthesiologica Scandinavica.

[10]  S. Ranta,et al.  A survey of the ASA physical status classification: significant variation in allocation among Finnish anaesthesiologists , 1997, Acta anaesthesiologica Scandinavica.

[11]  E. Spitznagel,et al.  ASA Physical Status Classifications: A Study of Consistency of Ratings , 1978, Anesthesiology.

[12]  W. Grove Statistical Methods for Rates and Proportions, 2nd ed , 1981 .

[13]  P. Lawler,et al.  An assessment of the consistency of ASA physical status classification allocation , 1995, Anaesthesia.

[14]  M. Cohen,et al.  Postoperative complications: factors of significance to anaesthetic practice , 1987, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[15]  M. Berger,et al.  Evaluation of the consistency of Acute Physiology and Chronic Health Evaluation (APACHE II) scoring in a surgical intensive care unit , 1992, Critical care medicine.

[16]  G. Smith,et al.  A review of studies of anaesthetic risk, morbidity and mortality. , 1987, British journal of anaesthesia.

[17]  L. Goffi,et al.  Preoperative APACHE II and ASA scores in patients having major general surgical operations: prognostic value and potential clinical applications. , 1999, The European journal of surgery = Acta chirurgica.

[18]  A. Keats The ASA classification of physical status--a recapitulation. , 1978, Anesthesiology.

[19]  A. Lake,et al.  ASA classification and perioperative variables: graded anaesthesia score? , 1997, British journal of anaesthesia.

[20]  T. Junginger,et al.  Predictive value of ASA classification for the assessment of the perioperative risk. , 1993, International surgery.

[21]  G. Pierer,et al.  Can ASA grade or Goldman's cardiac risk index predict peri‐operative mortality? A study of 16 227 patients , 1997, Anaesthesia.

[22]  Meyer Saklad,et al.  GRADING OF PATIENTS FOR SURGICAL PROCEDURES , 1941 .

[23]  U. Wolters,et al.  Risk factors, complications, and outcome in surgery: a multivariate analysis. , 1997, The European journal of surgery = Acta chirurgica.

[24]  M. Lum,et al.  Measuring Anaesthetic Outcomes , 1996, Anaesthesia and intensive care.

[25]  S. Arvidsson,et al.  Predicting postoperative adverse events. Clinical efficiency of four general classification systems The Project Perioperative Risk , 1996, Acta anaesthesiologica Scandinavica.

[26]  M. Lum,et al.  Early postoperative emergencies requiring an intensive care team interventionThe role of ASA physical status and after‐hours surgery , 1998, Anaesthesia.

[27]  S. Robinson Broken code--the ASA classification exposed. , 1979, Anesthesiology.

[28]  C. Bodian,et al.  Prolonged surgery increases the likelihood of admission of scheduled ambulatory surgery patients. , 1997, Journal of clinical anesthesia.

[29]  H. Iwagaki,et al.  Can POSSUM, a scoring system for perioperative surgical risk, predict postoperative clinical course? , 1998, Acta medica Okayama.