An evaluation of the accuracy and self-reported confidence of clinicians in using the ASA-PS Classification System - 28/04/22
, Ronald Figueiredo Gomes, (MD) b, Arthur de Campos Vieira Abib, (MD) a, Joaquim Edson Vieira, (MD) c, Anthony M.-H. Ho, (MD) d, Helidea de Oliveira Lima, (MSc) e, Fernando Nardy Bellicieri, (MD) a, Daenis Camire, (MD) d, Rafael Sousa Fava Nersessian, (MD) a, Glenio B. Mizubuti, (MD) dAbstract |
Objectives |
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.
Design |
Prospective before-and-after web-based study.
Participants |
272 anesthesiologists and 114 non-anesthesiologists.
Interventions |
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.
Measurements |
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.
Results |
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).
Conclusions |
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.
Le texte complet de cet article est disponible en PDF.Highlights |
• | 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. |
Keywords : Decision making, Surveys and questionnaires, Health status, Perioperative care, Continuing education
Plan
Vol 79
Article 110794- août 2022 Retour au numéro
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