Perioperative Medicine  |   April 2017
Adding Examples to the ASA-Physical Status Classification Improves Correct Assignment to Patients
Author Notes
  • From the Department of Anesthesiology and Pain Management (E.E.H.) and Department of Clinical Sciences (A.M.), University of Texas Southwestern Medical Center, Dallas, Texas; and Department of Anesthesiology, The University of Texas Medical Branch, Galveston, Texas (M.S., S.R.V., C.F.Z., S.M.S., A.E.A.). Department to which work attributed: University of Texas Medical Branch, Galveston, Texas.
  • Corresponding article on page 577.
    Corresponding article on page 577.×
  • Submitted for publication February 16, 2016. Accepted for publication January 5, 2017.
    Submitted for publication February 16, 2016. Accepted for publication January 5, 2017.×
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Address correspondence to Dr. Hurwitz: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, Texas 75390. erin.hurwitz@gmail.com. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Cardiovascular Anesthesia / Gastrointestinal and Hepatic Systems / Respiratory System
Perioperative Medicine   |   April 2017
Adding Examples to the ASA-Physical Status Classification Improves Correct Assignment to Patients
Anesthesiology 4 2017, Vol.126, 614-622. doi:10.1097/ALN.0000000000001541
Anesthesiology 4 2017, Vol.126, 614-622. doi:10.1097/ALN.0000000000001541
Abstract

Background: Despite its widespread use, the American Society of Anesthesiologists (ASA)-Physical Status Classification System has been shown to result in inconsistent assignments among anesthesiologists. The ASA-Physical Status Classification System is also used by nonanesthesia-trained clinicians and others. In 2014, the ASA developed and approved examples to assist clinicians in determining the correct ASA-Physical Status Classification System assignment. The effect of these examples by anesthesia-trained and nonanesthesia-trained clinicians on appropriate ASA-Physical Status Classification System assignment in hypothetical cases was examined.

Methods: Anesthesia-trained and nonanesthesia-trained clinicians were recruited via email to participate in a web-based questionnaire study. The questionnaire consisted of 10 hypothetical cases, for which respondents were first asked to assign ASA-Physical Status using only the ASA-Physical Status Classification System definitions and a second time using the newly ASA-approved examples.

Results: With ASA-approved examples, both anesthesia-trained and nonanesthesia-trained clinicians improved in mean number of correct answers (out of possible 10) compared to ASA-Physical Status Classification System definitions alone (P < 0.001 for all). However, with examples, nonanesthesia-trained clinicians improved more compared to anesthesia-trained clinicians. With definitions only, anesthesia-trained clinicians (5.8 ± 1.6) scored higher than nonanesthesia-trained clinicians (5.4 ± 1.7; P = 0.041). With examples, anesthesia-trained (7.7 ± 1.8) and nonanesthesia-trained (8.0 ± 1.7) groups were not significantly different (P = 0.100).

Conclusions: The addition of examples to the definitions of the ASA-Physical Status Classification System increases the correct assignment of patients by anesthesia-trained and nonanesthesia-trained clinicians.