Shichino Tsutomu, Hirao Motohiro, Haga Yoshio
Department of Anesthesia National Hospital Organization Kyoto Medical Center Kyoto Japan.
Department of Surgery National Hospital Organization Osaka National Hospital Osaka Japan.
Acute Med Surg. 2016 Sep 13;4(2):161-165. doi: 10.1002/ams2.241. eCollection 2017 Apr.
The American Society of Anesthesiologists Physical Status (ASA-PS) classification system is used worldwide and has also been incorporated into various prediction rules. However, concerns have been raised regarding inter-rater agreement in various surgical fields. Although emergency gastrointestinal surgery is relatively common and associated with high postoperative mortality, a reliability study has not yet been undertaken in this field. The aim of the present study was to investigate the inter-rater reliability of ASA-PS for emergency gastrointestinal surgery.
Three sets of scenarios were generated for each ASA-PS class (2E, 3E, and 4E) in emergency gastrointestinal surgery, resulting in nine scenarios. These scenarios described the preoperative profiles of patients in one hospital. Two or three anesthesiologists from 18 other hospitals provided scores for ASA-PS for each scenario.
Fifty anesthesiologists scored the ASA-PS class. Between 66% and 90% of these anesthesiologists assigned the same ratings as the reference ratings for the individual scenarios. Inter-rater reliability was assessed using Fleiss' kappa (95% confidence interval) of 0.55 (0.54-0.56, < 0.001) and an intraclass correlation coefficient (95% confidence interval) of 0.79 (0.63-0.93, < 0.001).
The results of the present study revealed the consistency of ASA-PS ratings between anesthesiologists for emergency gastrointestinal surgery. The ASA-PS may serve as a reliable variable in the prediction rules for this field.
美国麻醉医师协会身体状况（ASA-PS）分类系统在全球范围内使用，并且已被纳入各种预测规则。然而，不同手术领域的评分者间一致性受到了关注。尽管急诊胃肠手术相对常见且术后死亡率高，但该领域尚未进行可靠性研究。本研究的目的是调查急诊胃肠手术中ASA-PS评分者间的可靠性。
针对急诊胃肠手术中的每个ASA-PS等级（2E、3E和4E）生成三组病例场景，共九个场景。这些场景描述了一家医院患者的术前情况。来自其他18家医院的两到三名麻醉医师为每个场景的ASA-PS评分。
50名麻醉医师对ASA-PS等级进行了评分。其中66%至90%的麻醉医师给出的评分与各病例场景的参考评分相同。评分者间可靠性采用Fleiss卡方检验（95%置信区间）为0.55（0.54 - 0.56，<0.001），组内相关系数（95%置信区间）为0.79（0.63 - 0.93，<0.001）。
本研究结果显示了急诊胃肠手术中麻醉医师对ASA-PS评分的一致性。ASA-PS可能作为该领域预测规则中的一个可靠变量。
