An evaluation of the accuracy and self-reported confidence of clinicians in using the ASA-PS Classification System

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorSILVEIRA, Saullo Queiroz
dc.contributor.authorSILVA, Leopoldo Muniz da
dc.contributor.authorGOMES, Ronald Figueiredo
dc.contributor.authorABIB, Arthur de Campos Vieira
dc.contributor.authorVIEIRA, Joaquim Edson
dc.contributor.authorHO, Anthony M-H
dc.contributor.authorLIMA, Helidea de Oliveira
dc.contributor.authorBELLICIERI, Fernando Nardy
dc.contributor.authorCAMIRE, Daenis
dc.contributor.authorNERSESSIAN, Rafael Sousa Fava
dc.contributor.authorMIZUBUTI, Glenio B.
dc.date.accessioned2022-10-26T14:13:09Z
dc.date.available2022-10-26T14:13:09Z
dc.date.issued2022
dc.description.abstractObjectives: 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 (kappa < 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.eng
dc.description.indexMEDLINEeng
dc.identifier.citationJOURNAL OF CLINICAL ANESTHESIA, v.79, article ID 110794, 8p, 2022
dc.identifier.doi10.1016/j.jclinane.2022.110794
dc.identifier.eissn1873-4529
dc.identifier.issn0952-8180
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/49062
dc.language.isoeng
dc.publisherELSEVIER SCIENCE INCeng
dc.relation.ispartofJournal of Clinical Anesthesia
dc.rightsrestrictedAccesseng
dc.rights.holderCopyright ELSEVIER SCIENCE INCeng
dc.subjectDecision makingeng
dc.subjectSurveys and questionnaireseng
dc.subjectHealth statuseng
dc.subjectPerioperative careeng
dc.subjectContinuing educationeng
dc.subject.otherphysical status classificationeng
dc.subject.otherreliabilityeng
dc.subject.otherconsistencyeng
dc.subject.otherassignmenteng
dc.subject.othermortalityeng
dc.subject.otherscoreeng
dc.subject.otherriskeng
dc.subject.wosAnesthesiologyeng
dc.titleAn evaluation of the accuracy and self-reported confidence of clinicians in using the ASA-PS Classification Systemeng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.affiliation.countryCanadá
hcfmusp.affiliation.countryisoca
hcfmusp.author.externalSILVA, Leopoldo Muniz da:DOr Inst Res & Educ IDOR, Sao Luiz Hosp ITAIM Rede DOr CMA Anestesia Team, Dept Anesthesiol, Sao Paulo, SP, Brazil
hcfmusp.author.externalGOMES, Ronald Figueiredo:DOr Inst Res & Educ IDOR, Sao Luiz Hosp Jabaquara, Dept Anesthesiol, Rede Dor, Brazil
hcfmusp.author.externalABIB, Arthur de Campos Vieira:DOr Inst Res & Educ IDOR, Sao Luiz Hosp ITAIM Rede DOr CMA Anestesia Team, Dept Anesthesiol, Sao Paulo, SP, Brazil
hcfmusp.author.externalHO, Anthony M-H:Queens Univ, Dept Anesthesiol & Perioperat Med, Kingston, ON, Canada
hcfmusp.author.externalLIMA, Helidea de Oliveira:Dept Qual & Safety Rede DOr, Sao Paulo, SP, Brazil
hcfmusp.author.externalBELLICIERI, Fernando Nardy:DOr Inst Res & Educ IDOR, Sao Luiz Hosp ITAIM Rede DOr CMA Anestesia Team, Dept Anesthesiol, Sao Paulo, SP, Brazil
hcfmusp.author.externalCAMIRE, Daenis:Queens Univ, Dept Anesthesiol & Perioperat Med, Kingston, ON, Canada
hcfmusp.author.externalNERSESSIAN, Rafael Sousa Fava:DOr Inst Res & Educ IDOR, Sao Luiz Hosp ITAIM Rede DOr CMA Anestesia Team, Dept Anesthesiol, Sao Paulo, SP, Brazil
hcfmusp.author.externalMIZUBUTI, Glenio B.:Queens Univ, Dept Anesthesiol & Perioperat Med, Kingston, ON, Canada
hcfmusp.citation.scopus4
hcfmusp.contributor.author-fmusphcSAULLO QUEIROZ SILVEIRA
hcfmusp.contributor.author-fmusphcJOAQUIM EDSON VIEIRA
hcfmusp.description.articlenumber110794
hcfmusp.description.volume79
hcfmusp.origemWOS
hcfmusp.origem.pubmed35367956
hcfmusp.origem.scopus2-s2.0-85127287734
hcfmusp.origem.wosWOS:000837859000004
hcfmusp.publisher.cityNEW YORKeng
hcfmusp.publisher.countryUSAeng
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