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Correspondence  |   January 2018
Keep American Society of Anesthesiologists Physical Status Classification System Simple, Stupid
Author Notes
  • Hadassah – Hebrew University Medical Center, Jerusalem, Israel (A.A.). alex@avidan.co.il
  • (Accepted for publication September 28, 2017.)
    (Accepted for publication September 28, 2017.)×
Article Information
Correspondence
Correspondence   |   January 2018
Keep American Society of Anesthesiologists Physical Status Classification System Simple, Stupid
Anesthesiology 1 2018, Vol.128, 225-226. doi:10.1097/ALN.0000000000001947
Anesthesiology 1 2018, Vol.128, 225-226. doi:10.1097/ALN.0000000000001947
To the Editor:
We read with great interest the paper of Hurwitz et al.1  that demonstrated more appropriate American Society of Anesthesiologists Physical Status Classification System scores (ASA scores) and reduced interrater variability when the subjective examples provided to the ASA score2  were used. We suspect, however, that routine use of these examples may hinder the universal application of the ASA score. First, the examples provided are not fully comprehensive, and they will need to be memorized and easily accessible. Perhaps a mobile app could be created to calculate the correct ASA score, but even this does not guarantee uniform application. Second, as Sweitzer3  emphasized in the accompanying editorial, the universal successful application of the ASA score is related to its simplicity. The ASA score has penetrated beyond anesthesia and even beyond human medicine.4  It may even be considered on a par with the Apgar score.5 
We hesitate to support the authors’ recommendation to use the examples to the ASA score, instead of using common sense and simple rules. Having a list of examples transforms a simple albeit subjective universal score into a cumbersome one. Keep it simple, stupid (KISS).6 
Competing Interests
The authors declare no competing interests.
Alexander Avidan, M.D., Carolyn F. Weiniger, M.B., Ch.B. Hadassah – Hebrew University Medical Center, Jerusalem, Israel (A.A.). alex@avidan.co.il
References
Hurwitz, EE, Simon, M, Vinta, SR, Zehm, CF, Shabot, SM, Minhajuddin, A, Abouleish, AE Adding examples to the ASA-Physical Status Classification improves correct assignment to patients. Anesthesiology 2017; 126:614–22 [Article] [PubMed]
ASA Physical Status Classification System. Available at: https://www.asahq.org/resources/clinical-information/asa-physical-status-classification-system. Accessed March 14, 2017
Sweitzer, B Three wise men (×2) and the ASA-Physical Status Classification System. Anesthesiology 2017; 126:577–8 [Article] [PubMed]
Zeltzman, PHow ASA scores help make anesthesia safer for your pet patients. Available at: http://www.veterinarypracticenews.com/how-asa-scores-help-make-anesthesia-safer-for-your-pet-patients/. Accessed March 14, 2017
Apgar, V A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg 1953; 32:260–7 [Article] [PubMed]
Kiss principle. Available at: https://en.wikipedia.org/wiki/KISS_principle. Accessed March 14, 2017