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Clinical agreement in the American Society of Anesthesiologists physical status classification

Overview of attention for article published in Perioperative Medicine, June 2018
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Title
Clinical agreement in the American Society of Anesthesiologists physical status classification
Published in
Perioperative Medicine, June 2018
DOI 10.1186/s13741-018-0094-7
Pubmed ID
Authors

Kayla M. Knuf, Christopher V. Maani, Adrienne K. Cummings

Abstract

The American Society of Anesthesiologists physical status (ASA-PS) classification is not intended to predict risk, but increasing ASA-PS class has been associated with increased perioperative mortality. The ASA-PS class is being used by many institutions to identify patients that may require further workup or exams preoperatively. Studies regarding the ASA-PS classification system show significant variability in class assignment by anesthesiologists as well as providers of different specialties when provided with short clinical scenarios. Discrepancies in the ASA-PS accuracy have the potential to lead to unnecessary testing and cancelation of surgical procedures. Our study aimed to determine whether these differences in ASA-PS classification were present when actual patients were evaluated rather than previously published scenario-based studies. A retrospective chart review was completed for patients >/= 65 years of age undergoing elective total hip or total knee replacements. One hundred seventy-seven records were reviewed of which 101 records had the necessary data. The outcome measures noted were the ASA-PS classification assigned by the internal medicine clinic provider, the ASA-PS classification assigned by the Pre-Anesthesia Unit (PAU) clinic provider, and the ASA-PS classification assigned on the day of surgery (DOS) by the anesthesia provider conducting the anesthetic care. A statistically significant difference was shown between the internal medicine and the PAU preoperative ASA-PS designation as well as between the internal medicine and DOS designation (McNemar p = 0.034 and p = 0.025). Low kappa values were obtained confirming the inter-observer variation in the application of the ASA-PS classification of patients by providers of different specialties [Kappa of 0.170 (- 0.001, 0.340) and 0.156 (- 0.015, 0.327)]. There was disagreement in the ASA-PS class designation between two providers of different specialties when evaluating the same patients with access to full medical records. When the anesthesia-run PAU and the anesthesia assigned DOS ASA-PS class designations were evaluated, there was agreement. This agreement was seen between anesthesia providers regardless of education or training level. The difference in the application of the ASA-PS classification in our study appeared to be reflective of department membership and not reflective of the individual provider's level of training.

Twitter Demographics

The data shown below were collected from the profile of 1 tweeter who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 19 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 19 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 5 26%
Student > Bachelor 3 16%
Student > Postgraduate 2 11%
Researcher 2 11%
Professor > Associate Professor 2 11%
Other 2 11%
Unknown 3 16%
Readers by discipline Count As %
Medicine and Dentistry 11 58%
Nursing and Health Professions 2 11%
Business, Management and Accounting 1 5%
Unknown 5 26%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 20 June 2018.
All research outputs
#10,451,402
of 13,110,606 outputs
Outputs from Perioperative Medicine
#103
of 118 outputs
Outputs of similar age
#200,489
of 268,114 outputs
Outputs of similar age from Perioperative Medicine
#1
of 1 outputs
Altmetric has tracked 13,110,606 research outputs across all sources so far. This one is in the 11th percentile – i.e., 11% of other outputs scored the same or lower than it.
So far Altmetric has tracked 118 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.0. This one is in the 1st percentile – i.e., 1% of its peers scored the same or lower than it.
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