Variability of ASA physical status class assignment among pediatric sedation practitioners

Our goal was to determine the consistency of the Society of Anesthesiologists Physical Status (ASA-PS) Classification Scale with respect to different training, experience, and activity levels. A questionnaire comprised of 10 pediatric sedation scenarios was distributed via electronic mailing lists. Data were collected on training, experience, annual sedations performed, and ASA-PS score assigned. 100 questionnaires (38 anesthesiologists, 8 advanced nurses, 14 hospitalists, 22 intensivists, 15 registered nurses (RN), 3 others) were returned. Ratings for four scenarios varied significantly with respect to practitioner (p < .05). In one of the scenarios, pediatric hospitalists were more likely to rank a higher ASA-PS score, whereas registered nurses were more likely to rate patient scenarios at a lower ASA-PS (OR = 11.78, 95%CI = (2.10, 66.07), p-value = .0051). Number of annual sedations and practicing years were different among practitioner groups (p-values = .0019 and < .0001 respectively). In three scenarios, practitioners rated a lower ASA-PS score for each additional year in practice. The ASA-PS scores for two scenarios were marginally lower if the practitioner performed greater than 1000 sedations each year (p < .1). Our results indicate that the type of training and experience affect a practitioner's view of the severity of a patient's condition.