An evaluation of the accuracy and self-reported confidence of clinicians in using the ASA-PS Classification System

• Published in: Journal of clinical anesthesia Vol. 79; p. 110794
• Main Authors: Silveira, Saullo Queiroz, da Silva, Leopoldo Muniz, Gomes, Ronald Figueiredo, de Campos Vieira Abib, Arthur, Vieira, Joaquim Edson, Ho, Anthony M.-H., de Oliveira Lima, Helidea, Bellicieri, Fernando Nardy, Camire, Daenis, Nersessian, Rafael Sousa Fava, Mizubuti, Glenio B.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2022; Elsevier Limited
• Subjects: Accuracy; Adult; Anesthesiologists; Azides; Blood pressure; Body mass index; Calibration; Childbirth & labor; Classification; Continuing education; Data collection; Decision making; Gastroesophageal reflux; Gestational age; Health status; Heart rate; Hernias; Humans; Hypertension; Infant, Newborn; Medical personnel; Perioperative care; Phosphatidylserines; Physicians; Pregnancy; Prospective Studies; Questionnaires; Reproducibility of Results; Self Report; Surgery; Surveys and questionnaires; Continuing education; Surveys and questionnaires; Health status; Perioperative care; Decision making
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2022.110794

The American Society of Anesthesiologists Physical Status (ASA-PS) is a grading system routinely adopted worldwide by physicians to classify patients' overall health status. Concerns have been raised surrounding the subjectiveness of this system, potentially leading to poor inter-rater agreement/reliability. We hypothesized that physicians are overconfident when assigning ASA-PS scores and that presenting them with the ASA-PS definitions/examples would improve accuracy. We therefore evaluated participants' accuracy and self-reported confidence on the ASA-PS Classification System (1) while assigning ASA-PS according to their baseline knowledge/judgment; and (2) after a single exposure to the ASA-PS definitions/examples.
Prospective before-and-after web-based study.
272 anesthesiologists and 114 non-anesthesiologists.
Participants voluntarily answered a web-based questionnaire consisting of 10 hypothetical cases. They were asked to assign an ASA-PS score and rate their perceived self-confidence level (20–100%) on the accuracy of their assigned score for each case both (1) before and (2) after reviewing the ASA-PS definitions/examples. The correct ASA-PS for each hypothetical case was determined by consensus among investigators.
Participants' accuracy, self-reported confidence, and calibration of confidence on the application of ASA-PS Classification System. Agreement between measures was tested using kappa coefficient.
Anesthesiologists had better accuracy than non-anesthesiologists both on initial [6(5–7) vs. 4(3–5) out of 10; p < 0.001] as well as subsequent [7(6–8) vs. 6(4–7); p < 0.001] ASA-PS score assignments. Participants' self-reported confidence was greater than their accuracy for assigned ASA-PS scores (p < 0.001). ASA-PS agreement between anesthesiologists and non-anesthesiologists was poor (κ < 0.20). Participants' accuracy for hypothetical cases of ASA-PS I, II, and III involving adult patients was overall greater than for ASA-PS IV, V, and III (the latter involving a neonate) for both anesthesiologists and non-anesthesiologists (p < 0.001).
Physicians tend to disagree and be overconfident when assigning ASA-PS scores. A brief consultation of the ASA-PS definitions/examples improves the accuracy for both anesthesiologists and non-anesthesiologists.
•Physicians tend to be overconfident when applying the ASA-PS Classification System.•Anesthesiologists and non-anesthesiologists disagree when assigning ASA-PS scores.•A brief consultation of ASA-PS definitions/examples improves physicians' accuracy.•Accuracy for ASA-PS classes I, II and III is greater than for classes IV and V.•Clinicians often disregard acute life-threatening conditions when assigning ASA-PS.