Assessment of the variation in American Society of Anaesthesiologists Physical Status Classification assignment in small animal anaesthesia

作者：McMillan Matthew^*; Brearley Jacqueline

来源：Veterinary Anaesthesia and Analgesia, 2013, 40(3): 229-236.

DOI：10.1111/vaa.12007

• American Society of Anesthesiologists
• health
• interobserver variability
• physical status
• pre-anaesthetic assessment
• scoring systems
• status

Objective To evaluate the interobserver variability in the assignment of the American Society of Anesthesiologists Physical Status Classification (ASA-PSC) to compromised small animal patients amongst a group of veterinary anaesthetists. Study design Anonymous internet survey. Animals Hypothetical case presentations. Methods Sixteen hypothetical small animal cases with differing degrees of physiological or patho-physiological compromise were presented as part of an internet survey. Respondents were asked to assign a single ASA-PSC to each case and also to answer a number of demographic questions. ASA-PSC scores were considered separately and then grouped as scores of III and IIIV. Agreement was analysed using the modified kappa statistic for multiple observers. Data were then sorted into various demographic groups for further analysis. Results There were 144 respondents of which 60 (similar to 42%) were anaesthesia diplomates, 24 (similar to 17%) were post-residency (nondiploma holders), 24 (similar to 17%) were current anaesthesia residents, 21 (similar to 15%) were general practitioners, 12 (similar to 8%) were veterinary nurses or technicians, and 3 (similar to 2%) were interns. Although there was a majority agreement (>50% in a single category) in 15 of the 16 cases, ASA-PSC were spread over at least three ASA-PS classifications for every case. Overall agreement was considered only fair (=0.24, mean +/- SD agreement 46 +/- 7%). When comparing grouped data (ASA-PSC III versus III-V) overall agreement remained fair (=0.36, mean +/- SD agreement 69 +/- 19%). There was no difference in ASA-PSC assignment between any of the demographic groups investigated. Conclusions and clinical relevance This study suggests major discrepancies can occur between observers given identical information when using the ASA-PSC to categorise health status in compromised small animal patients. The significant potential for interobserver variability in classification allocation should be borne in mind when the ASA-PSC is used for clinical, scientific and statistical purposes.

• 出版日期2013-5