Abstract
BackgroundIndividualized treatment is a common principle in hospitals. Treatment decisions are made based on the patient’s condition, including comorbidities. This principle is equally relevant out-of-hospital. Furthermore, comorbidity is an important risk-adjustment factor when evaluating pre-hospital interventions and may aid therapeutic decisions and triage. The American Society of Anesthesiologists Physical Status (ASA-PS) classification system is included in templates for reporting data in physician-staffed pre-hospital emergency medical services (p-EMS) but whether an adequate full pre-event ASA-PS can be assessed by pre-hospital physicians remains unknown. We aimed to explore whether pre-hospital physicians can score an adequate pre-event ASA-PS with the information available on-scene.MethodsThe study was an inter-rater reliability study consisting of two steps. Pre-event ASA-PS scores made by pre- and in-hospital physicians were compared. Pre-hospital physicians did not have access to patient records and scores were based on information obtainable on-scene. In-hospital physicians used the complete patient record (Step 1). To assess inter-rater reliability between pre- and in-hospital physicians when given equal amounts of information, pre-hospital physicians also assigned pre-event ASA-PS for 20 of the included patients by using the complete patient records (Step 2). Inter-rater reliability was analyzed using quadratic weighted Cohen’s kappa (κw).ResultsFor most scores (82%) inter-rater reliability between pre-and in-hospital physicians were moderate to substantial (κw 0,47-0,89). Inter-rater reliability was higher among the in-hospital physicians (κw 0,77 to 0.85). When all physicians had access to the same information, κw increased (κw 0,65 to 0,93).ConclusionsPre-hospital physicians can score an adequate pre-event ASA-PS on-scene for most patients. To further increase inter-rater reliability, we recommend access to the full patient journal on-scene. We recommend application of the full ASA-PS classification system for reporting of comorbidity in p-EMS.
Highlights
Individualized treatment is a common principle in hospitals
The aim of the present study was to explore whether it is possible for pre-hospital physicians to score an adequate pre-event American Society of Anesthesiologists Physical Status (ASA-PS) already while on-scene
Pre-event ASA-PS was registered for a total of 312 patients
Summary
Treatment decisions are made based on the patient’s condition, including comorbidities Tailored treatment through adapted choice of therapy, medication and monitoring to each patient is a common principle in hospitals [1,2,3]. Stratification on comorbidity, and individualized treatment, is relevant and valid for pre-hospital patients. In line with this principle, the patient’s health status before the acute event should be accounted for in triage on-scene and to determine threshold for, and timing of interventions and physiological targets [7, 8]
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