Help me improve the ASA fitness classification system
November 9, 2012 10:20 AM Subscribe
The ASA physical status classification system is used by anaesthesiologists, surgeons and epidemiologists the world over. It has a major flaw - it makes no odds whether index patients have 1 or 5 systemic diseases: only the leading/worst is counted. This has the advantage of simplicity but is potentially misleading and should be done better in the 21st century. Numbercrunchers with a biomedical background needed ...
posted by kairab to Health & Fitness (4 answers total) 2 users marked this as a favorite
I have often thought that one (admittedly slightly tedious) way of overcoming the major limitation of the American Society of Anesthesiologists' (ASA) Physical Status classification system
, i.e. that whether your patient has 1 or 5 diseases it counts the same - would be to sum morbidity severities:
e.g. Asthma, mild (2) + HT, mild (2) + Angina, mild (2) + renal impairment, mild (2) totals 8, compared to COPD, severe and a constant threat to life (4) totals 4.
There is a certain logic to doing that, but epidemiologists would need to spend a few weekends crunching numbers to calculate adjustment factor(s) that adequately control(s) for imbalances (maybe give a 50 percent discount to all additional mild conditions or some such). And you would need to generate surgical survival curves (operator-receiver type?) to correlate with the "morbidity scores". Has anything like this been done using the ASA scheme as a starting point?