title: Assessment of the variation in American Society of Anesthesiologists [corrected] Physical Status Classification assignment in small animal anaesthesia.
abstract: 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.
  
  
  METHODS
  Anonymous internet survey.
  
  
  METHODS
  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 I-II and III-V. 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 (~42%) were anaesthesia diplomates, 24 (~17%) were post-residency (nondiploma holders), 24 (~17%) were current anaesthesia residents, 21 (~15%) were general practitioners, 12 (~8%) were veterinary nurses or technicians, and 3 (~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 (κ = 0.24, mean ± SD agreement 46 ± 7%). When comparing grouped data (ASA-PSC I-II versus III-V) overall agreement remained fair (κ = 0.36, mean ± SD agreement 69 ± 19%). There was no difference in ASA-PSC assignment between any of the demographic groups investigated.
  
  
  CONCLUSIONS
  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.
authors: Department of Clinical Veterinary Medicine, University of Cambridge, Cambridge, UK. mwm32@cam.ac.uk
authors: Matthew
authors: M
authors: McMillan
authors: Jacqueline
authors: J
authors: Brearley
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000009:adverse effects / Q000662:veterinary*; D017750:Animal Technicians; D000818:Animals; D003625:Data Collection; D004520:Education, Veterinary; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D057805:Pets / Q000502:physiology*; D017410:Practice Guidelines as Topic; D014481:United States; D018634:Veterinarians; D014730:Veterinary Medicine / Q000458:organization & administration / Q000592:standards*; D055815:Young Adult