Objectives The American Society of Anesthesiologists (ASA) Physical Status Classification Scale was created in 1947. The ASA scale has since been used as a surrogate for anesthetic risk and surgical prognosis. In the 1990s, an increasing number of nontraditional anesthesiology-trained providers have been called upon to provide deep sedation and pain control for patients outside the operating room. We sought to determine the consistency of the ASA scale with respect to different practitioner training, experience, and activity level.
Methods A questionnaire of 10 representative scenarios involving pediatric patients for sedation was developed. Practitioners were asked to assign an ASA status to each scenario. Data were also collected on training, length of time in practice, and number of annual sedations performed. The questionnaire was distributed to the respective electronic mailing lists of the practitioners' disciplines, including pediatric intensivists, anesthesiologists, hospitalists, and pediatric sedation. Fisher's exact test, ANOVA, and ordinal logistic regression were performed using SAS V8 (Cary, NC), with a p value < .05 defined as significant.
Results A total of 100 questionnaires were returned. Experience in years as well as annual sedations was ordered among physicians as (1)anesthesiologists, (2) intensivists, and (3) hospitalists. Four of the scenarios varied significantly with respect to type of practitioner (p < .05). Pediatric hospitalists were more likely to rank any given patient at a higher ASA score, whereas anesthesiologists and registered nurses were more likely to rate patient scenarios at a lower ASA. Practicing for greater than 10 years tended to make practitioners more likely to rate 3 of the 10 scenarios with a lower ASA. Independent of years in practice, the ASA score was also likely to be lower if the practitioner performed greater than 1,000 sedations each year.
Conclusions Our results indicate that type of training and amount of experience affect a practitioner's view of patient severity. ASA scores are frequently used as a surrogate for severity of illness when measuring program quality and outcomes measures. Standardized training needs to be instituted if ASA scales can be used as part of a reliable, valid measure for sedation outcomes across different practices.
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