Editorial Views  |   April 2017
Three Wise Men (×2) and the ASA-Physical Status Classification System
Author Notes
  • From the Department of Anesthesiology, Northwestern University, Chicago, Illinois.
  • Accepted for publication June 22, 2016.
    Accepted for publication June 22, 2016.×
  • Corresponding article on page 614.
    Corresponding article on page 614.×
  • Address correspondence to Dr. Sweitzer: Bobbie.sweitzer@northwestern.edu
Article Information
Editorial Views / Cardiovascular Anesthesia / Practice Management / Quality Improvement
Editorial Views   |   April 2017
Three Wise Men (×2) and the ASA-Physical Status Classification System
Anesthesiology 4 2017, Vol.126, 577-578. doi:10.1097/ALN.0000000000001542
Anesthesiology 4 2017, Vol.126, 577-578. doi:10.1097/ALN.0000000000001542
THE American Society of Anesthesiologists (ASA)-Physical Status score is ubiquitous in the literature and the practice of perioperative medicine. It is likely the most commonly applied classification system in medicine and is used worldwide. The ASA-Physical Status is subjective, and anesthesiologists frequently disagree on appropriate assignments such that studies have demonstrated low-to-moderate interrater reliability.1,2  It is not surprising that nonanesthesia-trained personnel struggle to use it, and the accuracy is often less than 50%.2,3  The study by Hurwitz et al. in this month’s issue of Anesthesiology is the first to look at whether the new conditions attached to the classification can improve correct assignments of ASA-Physical Status by nonanesthesia and anesthesia providers.3  All groups improved when provided examples. Interestingly, anesthesiologists improved the least when using the ASA-Physical Status examples. Why would the people who are most familiar with the classification score lower than nonanesthesia nurses? Are they ignorant of the grading system? Do they interpret the case histories differently? Do they refuse to match patients to a nonevidence-based list, or do they rely on complex decision-making based on intuition and experience honed over years?
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