Medical risk classification of dental patients in The Netherlands

This study centers on the general health of dental patients, evaluated on the basis of the physical status classification system of the American Society of Anesthesiologists (ASA). A total of 4,087 patients completed a risk-related, patient-administered questionnaire. On the basis of their medical data, a computerized ASA classification was determined for each patient: 63.3 percent were in ASA class I, 25.7 percent in class II, 8.9 percent in class III, and 2.1 percent in class IV. After verification and/or consultation with the physician, the dentist also determined the ASA class, and this was compared with the computerized outcome. The agreement expressed as a kappa value was 0.64; the computer result generally placed the patient in a higher category of medical risk. The computer-determined ASA classes differed among the various dental practices (chi 2 = 262.9; df = 138; P < .01). It is possible to estimate the risk class of dental patients on the basis of standardized medical information only; however, the definitive ASA class can only be determined after verification of the patient's reply or, in some cases, after consultation with a physician.