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Published on: January 6, 2011
A novel classification instrument for intraoperative awareness events
George A Mashour1, Roy K Esaki, Kevin K Tremper
1Department of Anesthesiology, University of Michigan Medical School, 1H247 UH/SPC-5048, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5048, USA. gmashour@umich.edu
Anesthesia and Analgesia
|August 29, 2009
Summary
A new classification system for intraoperative awareness events was developed. This system demonstrates excellent agreement among observers, aiding future research into anesthesia awareness.
Area of Science:
- Anesthesiology
- Patient Safety
- Medical Classification Systems
Background:
- Intraoperative awareness with explicit recall affects 1-2 per 1000 patients.
- Understanding awareness and its sequelae requires multi-study data compilation.
- A standardized method for describing awareness events is needed.
Purpose of the Study:
- To develop and validate a novel classification instrument for intraoperative awareness events.
- To establish a standardized method for reporting and analyzing awareness during anesthesia.
Main Methods:
- A classification system with 6 levels (0-5) for awareness severity was created.
- An additional designation 'D' for distress was included.
- 15 studies were reviewed, and events were classified by 25 independent observers; inter-observer agreement was assessed using Fleiss's kappa statistic.
Main Results:
- 151 adult intraoperative awareness cases were analyzed.
- Excellent inter-observer agreement was achieved for the basic awareness classes (kappa = 0.851).
- High agreement was also found when including the distress designation (kappa = 0.779).
Conclusions:
- A novel classification instrument for intraoperative awareness has been developed.
- The instrument demonstrates excellent inter-observer agreement.
- This classification system can facilitate future research on intraoperative awareness.
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