Assignment of pre-event ASA physical status classification by pre-hospital physicians: a prospective inter-rater reliability study

Kristin Tønsager; Marius Rehn; Andreas J Krüger; Jo Røislien; Kjetil G Ringdal

doi:10.1186/s12871-020-01083-x

Assignment of pre-event ASA physical status classification by pre-hospital physicians: a prospective inter-rater reliability study

BMC Anesthesiol. 2020 Jul 9;20(1):167. doi: 10.1186/s12871-020-01083-x.

Authors

Kristin Tønsager^{1

2

3}, Marius Rehn^{4

5

6}, Andreas J Krüger^{4

7}, Jo Røislien^{4

8}, Kjetil G Ringdal^{9

10

11}

Affiliations

¹ Department of Research, The Norwegian Air Ambulance Foundation, Oslo, Norway. kristin.tonsager@norskluftambulanse.no.
² Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway. kristin.tonsager@norskluftambulanse.no.
³ Faculty of Health Sciences, University of Stavanger, Stavanger, Norway. kristin.tonsager@norskluftambulanse.no.
⁴ Department of Research, The Norwegian Air Ambulance Foundation, Oslo, Norway.
⁵ Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.
⁶ Pre-hospital Division, Air Ambulance Department, Oslo University Hospital, Oslo, Norway.
⁷ Department of Emergency Medicine and Pre-Hospital Services, St. Olav's Hospital, Trondheim, Norway.
⁸ Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
⁹ Department of Anesthesiology, Vestfold Hospital Trust, Tønsberg, Norway.
¹⁰ Prehospital Division, Vestfold Hospital Trust, Tønsberg, Norway.
¹¹ Norwegian Trauma Registry, Oslo University Hospital, Oslo, Norway.

Abstract

Background: Individualized treatment is a common principle in hospitals. Treatment decisions are made based on the patient's condition, including comorbidities. This principle is equally relevant out-of-hospital. Furthermore, comorbidity is an important risk-adjustment factor when evaluating pre-hospital interventions and may aid therapeutic decisions and triage. The American Society of Anesthesiologists Physical Status (ASA-PS) classification system is included in templates for reporting data in physician-staffed pre-hospital emergency medical services (p-EMS) but whether an adequate full pre-event ASA-PS can be assessed by pre-hospital physicians remains unknown. We aimed to explore whether pre-hospital physicians can score an adequate pre-event ASA-PS with the information available on-scene.

Methods: The study was an inter-rater reliability study consisting of two steps. Pre-event ASA-PS scores made by pre- and in-hospital physicians were compared. Pre-hospital physicians did not have access to patient records and scores were based on information obtainable on-scene. In-hospital physicians used the complete patient record (Step 1). To assess inter-rater reliability between pre- and in-hospital physicians when given equal amounts of information, pre-hospital physicians also assigned pre-event ASA-PS for 20 of the included patients by using the complete patient records (Step 2). Inter-rater reliability was analyzed using quadratic weighted Cohen's kappa (κ_w).

Results: For most scores (82%) inter-rater reliability between pre-and in-hospital physicians were moderate to substantial (κ_w 0,47-0,89). Inter-rater reliability was higher among the in-hospital physicians (κ_w 0,77 to 0.85). When all physicians had access to the same information, κ_w increased (κ_w 0,65 to 0,93).

Conclusions: Pre-hospital physicians can score an adequate pre-event ASA-PS on-scene for most patients. To further increase inter-rater reliability, we recommend access to the full patient journal on-scene. We recommend application of the full ASA-PS classification system for reporting of comorbidity in p-EMS.

Keywords: Comorbidity; Critical care; Emergency medical services; Physicians; Pre-hospital emergency care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anesthesiologists
Emergency Medical Services*
Emergency Service, Hospital
Humans
Physicians*
Prospective Studies
Reproducibility of Results
Societies, Medical