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  1. Home
  3. Reliability Of The Pediatric-specific American Society Of Anesthesiologists Physical Status (asa-ps) Classification System
  1. Home
  3. Reliability Of The Pediatric-specific American Society Of Anesthesiologists Physical Status (asa-ps) Classification System

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Reliability of the Pediatric-Specific American Society of Anesthesiologists Physical Status (ASA-PS) Classification

Lucy Liu1,2, Lucy Foote1, Evgenia Kolyvaki3

  • 1Department of Anaesthesia, Great Ormond Street Hospital for Children, London, UK.

Paediatric Anaesthesia
|January 8, 2026

View abstract on PubMed

Summary
This summary is machine-generated.

Inter-rater reliability for the American Society of Anesthesiologists Physical Status (ASA-PS) classification in pediatric patients shows moderate agreement. Many pediatric patients are underscored, highlighting the need for improved ASA-PS scoring accuracy.

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Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Patient Safety

Background:

  • The American Society of Anesthesiologists Physical Status (ASA-PS) classification system is a standard for assessing patient comorbidities and perioperative risk.
  • Modifications have been made to the ASA-PS system since its 1941 inception, including pediatric-specific guidance in 2020.

Purpose of the Study:

  • To evaluate the inter-rater reliability of the ASA-PS classification system within the pediatric population.
  • To identify factors contributing to discrepancies in ASA-PS scoring among pediatric patients.

Main Methods:

  • A retrospective analysis of 364 pediatric patients at a quaternary hospital.
  • Three ASA-PS scores were assigned to each patient: one by the case anesthetist and two by independent consultant anesthetists.
  • Concordance was assessed using weighted kappa coefficients, with analysis of reasons for discordant scores.

    • Main Results:

    • Strong concordance was observed between the two independent consultant anesthetists (kappa = 0.76).
    • Moderate concordance was found between the case anesthetist and independent anesthetists (kappa = 0.5).
    • Discrepancies often involved the case anesthetist underscoring the ASA-PS score by one point, particularly in patients with complex conditions like symptomatic cardiac disease, abnormal BMI, oncologic states, brain malformations, or difficult airways.

    Conclusions:

    • Moderate inter-rater variability exists in pediatric ASA-PS scoring, with a tendency for underscoring.
    • Utilizing the 2020 ASA guidance for pediatric cases enhances scoring reliability.
    • Improved ASA-PS scoring accuracy can lead to better communication of perioperative risks in children.