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

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art_SILVEIRA_An_evaluation_of_the_accuracy_and_selfreported_confidence_2022.PDF (2.95 MB)
Citações na Scopus
4
Tipo de produção
article
Data de publicação
2022
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
ELSEVIER SCIENCE INC
Autores
SILVA, Leopoldo Muniz da
GOMES, Ronald Figueiredo
ABIB, Arthur de Campos Vieira
HO, Anthony M-H
LIMA, Helidea de Oliveira
BELLICIERI, Fernando Nardy
CAMIRE, Daenis
NERSESSIAN, Rafael Sousa Fava
Citação
JOURNAL OF CLINICAL ANESTHESIA, v.79, article ID 110794, 8p, 2022
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
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 (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.
Palavras-chave
Decision making, Surveys and questionnaires, Health status, Perioperative care, Continuing education
URI
https://observatorio.fm.usp.br/handle/OPI/49062
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MCG
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/08