DTIC ADA372352: Variability in the American Society of Anesthesiologists (ASA) Physical Status (PS) Classification Scale

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FROM : USUHS/GSN PHONE NO. : 3015995437 Oct. 08 1999 12:50PM P2
VARIABELITY IN THE AMERICAN SOCIETY OP ANESTHESIOLOGISTS (ASA)
PHYSICAL STATUS (PS) CLASSIFCATTON SCALE
Wendy Lynn Aronson
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ura S. MSAulifie, CRWA, PhD, Chair ^ate
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VARIABILITY IN THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS (ASA)
PHYSICAL STATUS (PS) CLASSIFICATION SCALE
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CAPT ARONSON WENDY L
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UNIFORMED SERVICES UNIV OF HEALTH SCIENC
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CIRRICULUM VITAE
Name: Wendy Lynn Aronson
Captain, United States Air Force, Nurse Corps
Graduate Student - Nurse Anesthesia Program
Uniformed Services University of the Health Sciences

Collegiate Institutions Attended:
Date: Institution: Degree: Date of Degree: Major:
1997-present Uniformed Services MSN October 1999 Nurse
University of the Anesthesia
Health Sciences
Bethesda, Maryland
1988-1991 University of BSN May 1991 Nursing
Wyoming
Laramie, Wyoming
1986-1987 University of Puget None Chemistry
Sound
Tacoma, Washington
Professional Positions:
Date: Position: Location:
1997-Present Graduate Student Uniformed Services University
of the Health Sciences
Bethesda, Maryland
1995-1997 StaffNurse Wright-Patterson Air Force Base
Coronary Care Unit Dayton, Ohio
1994-1995 Nurse Manager Mountain Home Air Force Base
Same Day Surgery Mountain Home, Idaho
1992-1995 StaffNurse Mountain Home Air Force Base
Multi-Service Unit Mountain Home, Idaho
1991-1992 Nurse Intern Travis Air Force Base
Fairfield, California
Professional Memberships and Certifications:
Associate Member, American Association of Nurse Anesthetists
Medical-Surgical Nursing Certification (1994)
Sigma Theta Tau (1999)
m
DISCLAIMER STATEMENT
Department of Defense
This work was supported by the Uniformed Services University of the Health Sciences
Protocol No. T06155-01. The opinions or assertions contained herein are the private
opinions of the authors and are not to be construed as official or reflecting the views of
the Department of Defense or the Uniformed Services University of the Health Sciences.
IV
COPYRIGHT STATEMENT
The author hereby certifies that the use of any copyrighted material in the thesis entitled:
"VARIABILITY IN THE ASA PHYSICAL STATUS CLASSIFICATION SCALE"
beyond brief exerpts is with the permission of the copyright owner, and will save and
hold harmless the Uniformed Services University of the Health Sciences from any
damage which may arise from such copyright violations.
ABSTRACT
The ASA PS classification is used world-wide by anesthesia providers to assess the
preoperative PS of patients. This score is used in many areas of anesthesia including
administrative policy-making, performance evaluations, resource allocation and
reimbursement of anesthesia services. In addition, it is cited as a variable in virtually all
research related to anesthesia and in many other areas of medical research as well.
The purpose of this study was to assess inter-rater reliability among anesthesia providers
in assigning ASA scores and discover possible sources of variability. A survey
containing four general questions and 10 hypothetical case scenarios was given to 70
anesthesia providers asking them to assign ASA scores and provide rationale for their
decisions. All subjects reported using the ASA PS classification routinely with nearly all
finding it helpful in their practice. Unfortunately, most of the sample viewed the ASA
PS as an anesthetic and surgical risk indicator. Findings demonstrate a lack of inter-rater
reliability in assigning ASA PS scores with a range in eight of the scenarios of three to
five and in only two of the scenarios a range of two. There were no statistical differences
between CRNAs and anesthesiologists or between military and non-military providers.
Several sources of variability were identified in this study: smoking, pregnancy, nature of
the surgery, potential difficult airway, and acute injury. This classification should not be
used for administrative policy determination or for reimbursement of anesthesia services
until it is revised by a multidisciplinary taskforce.
KeyWords: ASA PS. preoperative PS, assessment, physical status, classification.
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VARIABILITY IN THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS (ASA)
PHYSICAL STATUS (PS) CLASSIFICATION SCALE
by
Wendy Lynn Aronson
Capt, USAF, NC
Presented to the Graduate School of Nursing Faculty of
the Uniformed Services University of the Health
Sciences in Partial Fulfillment of the
Requirements for the
Degree of
MASTER OF SCIENCE
UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES
October 1999
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PREFACE
This research was conducted to provide insight into the sources of variability in
anesthesia providers use to the ASA PS classification. It was designed in an effort to
provide information that will be helpful in the revision of this classification.
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DEDICATION
I dedicate this work to the most important people in my life; my husband Andrew and
two sons Jesse and Jade. Without their love and support I would not have been able to
complete my masters and this research project. I dedicate this time in my life to the
friends I made here who have changed me (very much for the better) and have found a
place in my heart. I give God the glory for seeing me through each day and giving me
the strength to press on to the finish.
/ can do all things through Christ who strengthens me - Phil 4:13
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