Clinical agreement in the American Society of Anesthesiologists physical status classification
Autor: | Christopher V. Maani, Kayla M. Knuf, Adrienne K. Cummings |
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Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
Anesthesiology/standards
medicine.medical_specialty business.industry Medical record Research Preoperative care Training level lcsh:Surgery 030208 emergency & critical care medicine Perioperative lcsh:RD1-811 Variation between specialties Class (biology) 03 medical and health sciences 0302 clinical medicine McNemar's test 030202 anesthesiology Risk assessment/classification Family medicine Medicine business Kappa American society of anesthesiologists |
Zdroj: | Perioperative Medicine, Vol 7, Iss 1, Pp 1-6 (2018) Perioperative Medicine |
ISSN: | 2047-0525 |
Popis: | Background The American Society of Anesthesiologists physical status (ASA-PS) classification is not intended to predict risk, but increasing ASA-PS class has been associated with increased perioperative mortality. The ASA-PS class is being used by many institutions to identify patients that may require further workup or exams preoperatively. Studies regarding the ASA-PS classification system show significant variability in class assignment by anesthesiologists as well as providers of different specialties when provided with short clinical scenarios. Discrepancies in the ASA-PS accuracy have the potential to lead to unnecessary testing and cancelation of surgical procedures. Our study aimed to determine whether these differences in ASA-PS classification were present when actual patients were evaluated rather than previously published scenario-based studies. Methods A retrospective chart review was completed for patients >/= 65 years of age undergoing elective total hip or total knee replacements. One hundred seventy-seven records were reviewed of which 101 records had the necessary data. The outcome measures noted were the ASA-PS classification assigned by the internal medicine clinic provider, the ASA-PS classification assigned by the Pre-Anesthesia Unit (PAU) clinic provider, and the ASA-PS classification assigned on the day of surgery (DOS) by the anesthesia provider conducting the anesthetic care. Results A statistically significant difference was shown between the internal medicine and the PAU preoperative ASA-PS designation as well as between the internal medicine and DOS designation (McNemar p = 0.034 and p = 0.025). Low kappa values were obtained confirming the inter-observer variation in the application of the ASA-PS classification of patients by providers of different specialties [Kappa of 0.170 (− 0.001, 0.340) and 0.156 (− 0.015, 0.327)]. Conclusions There was disagreement in the ASA-PS class designation between two providers of different specialties when evaluating the same patients with access to full medical records. When the anesthesia-run PAU and the anesthesia assigned DOS ASA-PS class designations were evaluated, there was agreement. This agreement was seen between anesthesia providers regardless of education or training level. The difference in the application of the ASA-PS classification in our study appeared to be reflective of department membership and not reflective of the individual provider’s level of training. |
Databáze: | OpenAIRE |
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