Journal of Anesthesia

, Volume 32, Issue 2, pp 211–218 | Cite as

Interrater variability in ASA physical status assignment: an analysis in the pediatric cancer setting

  • Luis E. Tollinche
  • Gloria Yang
  • Kay-See Tan
  • Ruth Borchardt
Original Article



The American Society of Anesthesiologists (ASA) physical status is a universal classification system that helps clinicians to categorize their patients preoperatively. However, there is a lack of both inter-rater and intra-rater reliability among clinicians for the ASA physical status classification. Our study focuses on testing these reliabilities within pediatric anesthesia providers in the cancer setting.


In our retrospective observational study, a total of 1177 anesthesia records were reviewed. The cohort included all pediatric patients (≤ 18 years old) diagnosed with either retinoblastoma or neuroblastoma who had two or more anesthesia procedure within a 14-day time period.


Overall, the ASA physical status score among two different anesthesia providers for the same patient treated at different times had very little inter-rater reliability, κ = − 0.042 (95% CI − 0.17; 0.09). Of the 1177-patient anesthesia records, only 25% had two or more ASA physical status score assigned by the same anesthesiologist within a 14-day time period. There was moderate intra-rater reliability κ = 0.48 (95% CI 0.29; 0.68) for patients who were assigned an ASA physical status score by the identical anesthesia provider at different times points within a 14 day period.


In contrast to observations in earlier studies, findings indicate poor agreement in inter-rater reliability. Although there was moderate agreement in intra-rater reliability, one would expect to find stronger, even perfect, intra-rater reliability. These findings suggest the need to develop a specific physical status classification system directed toward patients with a systemic illness such as cancer in both young and adult patients.


ASA physical status Reliability Pediatric Cancer 


Author contributions

LT, GY, K-ST, RB: (all authors) were: 1—substantial contributors to the conception of the manuscript, 2—active participants in the drafting and revising of the manuscript, 3—approved of final version of manuscript, 4—agree to be accountable for all aspects of the work.


This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

EQUATOR guidelines

This manuscript adheres to the applicable EQUATOR guidelines PRISMA-P.


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Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and Critical Care MedicineMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA

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