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Classification of comorbidity in trauma: the reliability of pre-injury ASA physical status classification
Kjetil G Ringdal1, Nils Oddvar Skaga, Petter Andreas Steen
1Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway. kjetil.ringdal@norskluftambulanse.no
Insights
The American Society of Anesthesiologists Physical Status (ASA-PS) scale demonstrates moderate to substantial reliability for grading pre-injury comorbidity in trauma patients. This finding supports its use as a valuable tool in trauma data reporting and patient outcome prediction.
Area of Science:
- Trauma care and patient outcomes
- Medical record analysis
- Health services research
Background:
- Pre-injury comorbidities significantly impact outcomes for severely injured patients.
- The American Society of Anesthesiologists Physical Status (ASA-PS) classification is a recommended comorbidity score for trauma data.
- Reliability of pre-injury ASA-PS scoring in trauma patients is not well-established.
Purpose of the Study:
- To assess the reliability of the pre-injury American Society of Anesthesiologists Physical Status (ASA-PS) scale for grading comorbidity in trauma patients.
Main Methods:
- A reliability study involving 19 Norwegian trauma registry coders.
- Analysis of 50 anonymized patient medical records.
- Quadratic weighted kappa (κ(w)) and unweighted kappa (κ) analyses were used to measure reliability.
Main Results:
- Rater-against-reference standard reliability using κ(w) ranged from moderate (0.77) to substantial (0.95).
- Rater-against-reference standard reliability using κ ranged from fair (0.46) to substantial (0.83).
- Inter-rater reliability for κ(w) ranged from moderate (0.66) to substantial (0.96), and for κ from slight (0.36) to moderate (0.75).
Conclusions:
- The pre-injury ASA-PS scale shows moderate to substantial reliability for classifying trauma patient comorbidity.
- The findings support the use of the ASA-PS scale as a reliable measure in trauma registries.
- Reliability varied depending on the kappa measure used, with κ(w) generally indicating higher agreement.
Background:
Pre-injury comorbidities can influence the outcomes of severely injured patients. Pre-injury comorbidity status, graded according to the American Society of Anesthesiologists Physical Status (ASA-PS) classification system, is an independent predictor of survival in trauma patients and is recommended as a comorbidity score in the Utstein Trauma Template for Uniform Reporting of Data. Little is known about the reliability of pre-injury ASA-PS scores. The objective of this study was to examine whether the pre-injury ASA-PS system was a reliable scale for grading comorbidity in trauma patients.
Methods:
Nineteen Norwegian trauma registry coders were invited to participate in a reliability study in which 50 real but anonymised patient medical records were distributed. Reliability was analysed using quadratic weighted kappa (κ(w)) analysis with 95% CI as the primary outcome measure and unweighted kappa (κ) analysis, which included unknown values, as a secondary outcome measure.
Results:
Fifteen of the invitees responded to the invitation, and ten participated. We found moderate (κ(w)=0.77 [95% CI: 0.64-0.87]) to substantial (κ(w)=0.95 [95% CI: 0.89-0.99]) rater-against-reference standard reliability using κ(w) and fair (κ=0.46 [95% CI: 0.29-0.64]) to substantial (κ=0.83 [95% CI: 0.68-0.94]) reliability using κ. The inter-rater reliability ranged from moderate (κ(w)=0.66 [95% CI: 0.45-0.81]) to substantial (κ(w)=0.96 [95% CI: 0.88-1.00]) for κ(w) and from slight (κ=0.36 [95% CI: 0.21-0.54]) to moderate (κ=0.75 [95% CI: 0.62-0.89]) for κ.
Conclusions:
The rater-against-reference standard reliability varied from moderate to substantial for the primary outcome measure and from fair to substantial for the secondary outcome measure. The study findings indicate that the pre-injury ASA-PS scale is a reliable score for classifying comorbidity in trauma patients.
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