ASA physical status classification system
The ASA classification is a widely used in medicine scheme for classifying patients into different groups ( ASA physical status ) with respect to the physical condition. Opened in May 1941 by Saklad et al. entitled " Grading of patients for surgical procedures" by the American Society of Anesthesiologists (ASA) scheme proposed different patients from anesthesia based on systemic disorders.
- ASA 1: Normal, healthy patient
- ASA 2: A patient with mild systemic disease
- ASA 3: A patient with severe systemic disease
- ASA 4: A patient with severe systemic disease that is a constant threat to life.
- ASA 5: moribund patient who is not expected to survive without surgery
- ASA 6: brain-dead patient whose organs are being removed for organ donation
The ASA classification is used, inter alia, to patients of a hospital or of different doctors to be able to compare them.
A major problem of the ASA classification is the subjectivity of the assessment, which in only a slight degree of concordance ( 30-80 %) expressed when different anesthesiologists are asked to classify the same patient. Since various factors for the risk of surgery are more important than the ASA status, the classification is inappropriate for a forecast on the outcome of surgery to assess and evaluate the complication of a hospital as part of quality assurance. The assessment of the operational risk is not the meaning of the ASA score, but this score is intended to give a general assessment of the patient's status.
History
1940/41, was approved by the ASA, a committee of three physicians ( Meyer Saklad Emery Rovenstine and Ivan Taylor ) was commissioned to investigate a system, test, and implement, which allows for the collection and tabulation of statistical data in anesthesiology and under all circumstances could be used. This was the first effort of a medical specialty to stratify the risk for their patients. Although their task was to find predictors of operative risk, they have rejected the job because it would be impossible to implement. They said:
In Attempting to standardize and define What has heretofore been Considered ' Operational Risk ', it was found did the term ... Could not be used. It was felt did for the purposes of the anesthesia record and for any future evaluation of anesthetic agents or surgical procedures, it would be best to classify and grade the patient in relation to his physical status only. "
The scale, which they suggested, so alone noticed the preoperative risk of the patient, without considering the operational procedure or other factors that may influence the outcome. The authors hoped that anesthesiologists from all parts of America would accept this " common terminology ", thus enabling statistical conclusions of morbidity and mortality by comparing the results of " surgical procedure" and the preoperative condition of the patient.
They described a six-point scale, from healthy patients (Class 1) should represent a systemic with extreme dysfunction that an immediate danger to the life of the patient ( Class 4). The first four points on the scale roughly correspond to today's ASA classes 1 to 4, which were first published in 1963. The authors have included two more classes, described what emergencies that otherwise would have been coded as either Class 1-2 ( Class 5) or as Class 3-4 (Class 6 ). At the time of today's publication of the classification in 1963, two changes were made. First, the classes 5 and 6, and a new class 5 accounted for has been added ( see above). Second, the classes for emergencies were simply replaced by an "E" modifier of other classes. The sixth class is now used for brain-dead organ donors.
Saklad was for each class of samples to promote uniformity. Unfortunately, the ASA described later, no such examples in their classification, and reinforced by the confusion. This fact has led to criticism of the classification which would probably not have been necessary.
Original text from 1941 ( with translation )
The original classification of 1941 included some examples for the handling and disposition of the classification:
Examples: This includes patients suffering with fractures Unless shock, blood loss, systemic emboli or signs of injury are present in a individual who would otherwise drop in Class 1 It includes congenital deformities Unless They Are Causing systemic disturbance. Infections are localized and did not do cause fever, many osseous deformities, and uncomplicated hernias are included. Any type of operation june falling in this class since only the patient 's physical condition is considered.
Examples: This includes patients with bone fracture, except when there are shock, blood loss, systemic embolism or signs of injury in a person who would otherwise fall into Class 1. This includes congenital deformities, except when they cause systemic disorders. Infections, which are local and do not cause a fever, many bony deformities and uncomplicated hernias also covered. Any kind of surgery can fall into this class because only the physical state is considered.
Examples: Mild diabetes. Functional capacity I or IIa. Psychotic patients unable to care for Themselves. Mild acidosis. Anemia moderate. Septic or acute pharyngitis. Chronic sinusitis with postnasal discharge. Acute sinusitis. Minor or superficial infections did cause a systemic reaction. (If there is no systemic reaction, fever, malaise, leukocytosis, etc., aid in classifying. ) Nontoxic adenoma of thyroid Causes did but partial respiratory obstruction. Mild thyrotoxicosis. Acute osteomyelitis ( early). Chronic osteomyelitis. Pulmonary tuberculosis with involvement of pulmonary tissue insufficient to embarrass activity and without other symptoms.
Examples: Mild diabetes mellitus, Functional capacity I or IIa, psychotic patients who can not take care of themselves, mild acidosis, moderate anemia, septic or acute pharyngitis, chronic sinusitis with postnasalem discharge, acute sinusitis, minor or superficial infections, systemic reaction cause (if no systemic reaction is visible, fever, malaise, leukocytosis, etc., can in the classification help ), non-toxic adenoma of the thyroid gland which is only slightly the respiratory tract limiting, mild thyrotoxicosis, acute osteomyelitis, pulmonary tuberculosis with involvement of the lung tissue, non- sufficient to induce activity and no other symptoms.
Examples: Complicated or severe diabetes. Functional capacity IIb. Combinations of heart disease and respiratory disease or others did impair normal functions severely. Complete intestinal obstruction did Has Existed long enough to cause serious physiological disturbance. Pulmonary tuberculosis that, Because of the extent of the lesion or treatment, Has induced vital capacity Sufficiently to cause tachycardia or dyspnea. Patients debilitated by prolonged illness with weakness of all or several systems. Severe trauma from accident Resulting in shock, Which 'may be improved by treatment. Pulmonary abscess.
Examples: Complicated or severe diabetes mellitus, functional capacity IIb. Combinations of heart disease and respiratory disease or other diseases that impair normal function strong. Full ileus which is long enough to cause serious physiological disorders. Pulmonary tuberculosis, which results due to the extent of the lesions or the treatment of tachycardia or dyspnea. Patients who suffer from a prolonged illness at weakness of all or several systems. Severe trauma caused by an accident in shock, which can be improved by the treatment. Lung abscess.
Examples: Functional capacity III - (cardiac decompensation ). Severe trauma with irreparable damage. Complete intestinal obstruction of long duration in a patient who is already debilitated. A combination of cardiovascular - renal disease with marked renal impairment. Patients who must have anesthesia to arrest a secondary hemorrhage where the patient is in poor condition associated with marked loss of blood. Emergency Surgery: An emergency surgery is Arbitrarily defined as a surgical procedure Which, in the surgeon 's opinion, Should Be Performed without delay.
Examples: Functional capacity III ( decompensation of the heart), severe trauma with irreversible damage, complete intestinal obstruction over a longer period, in which the patient has already been ruled out, a combination of heart and renal disease with significant renal failure, patients should be placed under anesthesia to satisfy a secondary haemorrhage and the patient is already by blood loss in bad shape, emergency surgeries. An emergency surgery is arbitrarily defined as a surgical procedure that must be performed immediately after the opinion of the surgeon.