Is the ASA Classification Universal?

The physical status classification of the American Society of Anaesthesiology (ASA) is the most used score in the preoperative evaluation, but inconsistent evaluations and low reliability have been reported. The aim of this study is to evaluate the variability in the evaluation of ASA physical status classification among Portuguese anaesthesiologists.Cross-sectional study, in which an electronic questionnaire, was distributed to Portuguese anaesthesiologists with questions regarding their demographic characteristics, professional experience, place of work and how they would categorise 15 clinical cases regarding ASA classification. Three anaesthesiologists and a medicine student wrote the cases. Data analyses were done using R suite version 1.0.143 and IBM SPSS Statistics. The agreement among participants was evaluated through intraclass correlation coefficient (ICC). A value of P.05 was assumed as statistically significant.1,850 e-mails were sent, and 259 answers were obtained. Median age of participants was 47 years. 172 were female and 87 males. Ninety percent of work is in the public sector, and 99.6% use this classification on their daily practice. Participants' agreement ranged from 3 to 15 responses, with a mean of 9.2 (SD 6 2.4). In none of the cases was observed a total agreement with the author's classification. The ICC among the participants was 0.726 (0.585; 0.869; P.001), showing a moderate degree of agreement.The results of this sample revealed that the agreement among Portuguese anaesthetists is satisfactory and similar to the values observed in other countries where there were no significant differences between trainees and specialists.