Use of The American Society of Anaesthesiologists Physical Status Classification in non-trauma surgical versus trauma patients: a survey of inter-observer consistency

Abstract

Background: The American Society of Anaesthesiologists-Physical Status (ASA-PS) Classification is a grading system for classifying surgical patients based on their comorbid background. Despite numerous benefits, its highly subjective nature has led to marked inconsistency when used. The purpose of this study was to assess consistency when public sector anaesthetists score trauma and non-trauma surgical patients using the Classification.

Methods: A three-part questionnaire, with 18 clinical scenarios, was administered to 98 anaesthetists requiring them to grade the scenarios using the Classification and give their opinion on its usage.

Results: We received 97 completed questionnaires. Eighty-eight percent of respondents routinely use the Classification. Fifty-two percent had read the Classification within the last six months. Many limitations of the use of the ASA System were identified. There was a lack of consistency in the scoring of the scenarios, with each scenario receiving at least three different gradings. Scenarios involving trauma, paediatrics, neurosurgery and the airway were associated with greater inconsistency. There was a statistically significant (p < 0.01) difference in inter-rater variability between the trauma and non-trauma scenarios.

Conclusion: The ASA-PS Classification shows poor inter-rater consistency when trauma patients are scored compared to nontrauma patients. Anaesthetists found it an overall inadequate tool to be used perioperatively in its current state. There has been suggestion for a possible multifactorial modification with an aim to improve preoperative physical status and risk assessment of patients.