title: Adding Examples to the ASA-Physical Status Classification Improves Correct Assignment to Patients.
abstract: Despite its widespread use, the American Society of Anesthesiologists (ASA)-Physical Status Classification System has been shown to result in inconsistent assignments among anesthesiologists. The ASA-Physical Status Classification System is also used by nonanesthesia-trained clinicians and others. In 2014, the ASA developed and approved examples to assist clinicians in determining the correct ASA-Physical Status Classification System assignment. The effect of these examples by anesthesia-trained and nonanesthesia-trained clinicians on appropriate ASA-Physical Status Classification System assignment in hypothetical cases was examined.
  
  
  
  Anesthesia-trained and nonanesthesia-trained clinicians were recruited via email to participate in a web-based questionnaire study. The questionnaire consisted of 10 hypothetical cases, for which respondents were first asked to assign ASA-Physical Status using only the ASA-Physical Status Classification System definitions and a second time using the newly ASA-approved examples.
  
  
  
  With ASA-approved examples, both anesthesia-trained and nonanesthesia-trained clinicians improved in mean number of correct answers (out of possible 10) compared to ASA-Physical Status Classification System definitions alone (P < 0.001 for all). However, with examples, nonanesthesia-trained clinicians improved more compared to anesthesia-trained clinicians. With definitions only, anesthesia-trained clinicians (5.8 ± 1.6) scored higher than nonanesthesia-trained clinicians (5.4 ± 1.7; P = 0.041). With examples, anesthesia-trained (7.7 ± 1.8) and nonanesthesia-trained (8.0 ± 1.7) groups were not significantly different (P = 0.100).
  
  
  
  The addition of examples to the definitions of the ASA-Physical Status Classification System increases the correct assignment of patients by anesthesia-trained and nonanesthesia-trained clinicians.
authors.affiliation: From the Department of Anesthesiology and Pain Management (E.E.H.) and Department of Clinical Sciences (A.M.), University of Texas Southwestern Medical Center, Dallas, Texas; and Department of Anesthesiology, The University of Texas Medical Branch, Galveston, Texas (M.S., S.R.V., C.F.Z., S.M.S., A.E.A.). Department to which work attributed: University of Texas Medical Branch, Galveston, Texas.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Hurwitz
authors.forename: Michelle
authors.initials: M
authors.lastname: Simon
authors.forename: Sandhya R
authors.initials: SR
authors.lastname: Vinta
authors.forename: Charles F
authors.initials: CF
authors.lastname: Zehm
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Shabot
authors.forename: Abu
authors.initials: A
authors.lastname: Minhajuddin
authors.forename: Amr E
authors.initials: AE
authors.lastname: Abouleish
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000776:Anesthesiology / Q000379:methods*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D012955:Societies, Medical; D011795:Surveys and Questionnaires / Q000592:standards*