Inter-rater variability between anaesthetists when classifying patients the american society of anesthesiologists physical status (ASA-PS) classification system

Abstract

Background

Anaesthetists convey the physical state of patients by use of the American Society of Anaesthesiologists Physical Status classification system (ASA-PS). It is a simple, popular tool with many uses, but not without fault, where variation between anaesthetists when classifying patients exists. To date there is no South African study comparing inter-rater variability between anaesthetists particularly between junior and senior anaesthetists. Our study includes scenarios with patients with Human Immunodeficiency Virus (HIV). A „modifier‟ and it‟s level of acceptance is also proposed. Method

A questionnaire comprising of two parts was distributed. The first part assessed demographics and attitude towards a proposed “modifier” and the second consisted of ten hypothetical case scenarios which were created to incorporate a wide variety of conditions including Human Immunodeficiency Virus (HIV). Results

After receiving 134 of the 200 questionnaires distributed, 132 were analysed. There were 93 juniors and 39 seniors. A Cohen‟s kappa statistic over all the scenarios of 0.23 (fair agreement) was determined. In none of the scenarios was there complete agreement. In each case there was a majority viewpoint shared by both juniors and seniors except Scenario 2. Large ranges were found in scenarios which included pregnant, geriatric and emergency patients. Conclusion

Results are in keeping with other studies. Inter-rater variability is prevalent despite guidelines being available. A simple modifier such as letter “G” denoting a gravid patient may be acceptable