Adding Examples to the ASA–Physical Status Classification Improves Correct Assignment to Patients

A review of ASA physical status – historical perspectives and modern developments

“…Regrettably, little work was undertaken to measure the reliability with which the original ASA physical status was applied in the 20 years after its publication. Further changes were made to the scoring system, but these did not appear to be evidence‐based until 2014, when interest in the accuracy of an anaesthetic risk prediction system was rekindled, and a flurry of work was undertaken to describe and refine the classification .…”

“…The revisions from 1961 removed the case vignettes, which were thought to promote subjectivity and increase inter‐observer variability . Numerous articles have explored and quantified how changes could reduce inter‐observer reliability, many of which used hypothetical scenarios to ‘stress’ the system .…”

“…Hurwitz et al compared the application of the 2014 classification with the 1961 system. The re‐introduction of the case vignettes in the 2014 re‐classification reduced inter‐rater variability between anaesthesia‐trained clinicians compared with other clinicians, particularly at higher ASA physical status scores .…”

Importance of relying on examples for both anesthesiologists and other physicians to assign unbiased American Society of Anesthesiologists Physical Status Classifications

“…Contemporaneously with the study of Curatolo and colleagues, Hurwitz and colleagues tested the influence of the ASA-approved examples on scores assigned by anesthesiologists, internists, and surgeons [3]. In the latter study, "respondents were first given 10 hypothetical cases and asked to assign" the ASA PS "using only the ASA PS definitions.…”

American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions

“…When more than one comorbid condition exists, the likelihood of developing postoperative complication such as OIUAS and OIRD is increased (Fernandez-Bustamante et al, 2017;Gupta et al, 2018;Khelemsky et al, 2015;Lee et al, 2015;Pawasauskas et al, 2014;Rosenfeld et al, 2016;Schug, Palmer, Scott, Halliwell, & Trinca, 2016). For 50 years, anesthesia providers have used the American Society of Anesthesiologists (ASA) Physical Status Classifications system to rate a patient's risk of undergoing anesthesia (Hurwitz et al, 2017). This classification system is highly subjective and interrater reliability is moderate to low, especially when used by nonanesthesiologists, who consistently underscore ASA classification (Curatolo et al, 2017).…”