An assessment of interrater reliability of the ASA physical status classification in pediatric surgical patients

BACKGROUND: The American Society of Anesthesiologists physical status classification (ASA-PS) is used worldwide by anesthesia providers as an assessment of the preoperative physical status of patients. This assessment score has been inconsistently assigned by anesthesia providers among adult surgical patients. This study tested the reliability of assignment of ASA-PS classification among pediatric anesthesia providers. METHODS: A postal questionnaire was sent to a randomly selected sample of full members of the Society of Pediatric Anesthesiologists. Participants were asked to assign ASA-PS for 10 clinical case scenarios chosen from regular pediatric surgical cases at the investigators' institution. RESULTS: The response rate to our mailing was 54%. There was a moderate overall agreement among pediatric anesthesia providers in assigning ASA-PS for pediatric surgical patients (exact agreement 40.5-78.6%; kappa = 0.479). Exact agreement improved for combined ASA classifications of I and II (83%), and III and IV (95%). CONCLUSION: These findings suggest a moderate agreement among pediatric anesthesia providers in assigning ASA-PS classification to selected pediatric case scenarios. Most disagreement, however, represented a tendency of outside care providers to assign a higher ASA physical status for cases. Furthermore, agreement was excellent for low risk (i.e. ASA I and II) as well as high risk (ASA III and IV) cases.