Four questions to identify patients with ASA III or higher View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2019-04

AUTHORS

Bernhard Springer, Ulrich Bechler, Andi Kolodny, Kilian Rueckl, Friedrich Boettner

ABSTRACT

BACKGROUND: Increased age, obesity, and American Society of Anesthesiologists (ASA) Physical Status class III and IV have been reported as predictors for mortality and perioperative complications. High-volume institutions rely on central referral services as first contact point for patients. The current study reports on a simple four-step questionnaire to identify patients with ASA-physical status class III and IV to improve referral processes and optimize perioperative work ups. MATERIALS AND METHODS: Seven hundred and seventy-five patients who called the physician referral service (PRS) at the author's institution and subsequently underwent surgery were enrolled in this study. The answers to the initial PRS questionnaire were analyzed. The study cohort consisted of 414 women (53.4%) and 361 men (46.6%) with an average age of 61.4 years (range 44-90 years) at the time of surgery. RESULTS: Binary logistic regression revealed hypertension, diabetes mellitus (using medication), using blood thinner (other than Aspirin) and a number of 4-9 prescribed medication, respectively, as predictors for ASA III and IV. Receiver-operating characteristic (ROC) curve analysis identified a sensitivity of 82.4%, a specificity of 82.9%, and an accuracy of 82.8%, when two of these four questions are answered "yes". The area under the curve for this analysis was 0.876 [95% confidence interval (CI) 0.845-0.908]. Positive and negative likelihood ratios were 4.8 (95% CI 4.0-5.8) and 0.2 (95% CI 0.1-0.3), respectively. CONCLUSIONS: This study revealed a simple four-step questionnaire to identify patients with ASA III or IV before a medical appointment. This helps to balance referrals between multiple providers in high-volume medical groups. More... »

PAGES

461-466

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00402-018-3078-7

DOI

http://dx.doi.org/10.1007/s00402-018-3078-7

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1111250687

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30617519


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JSON-LD is a popular format for linked data which is fully compatible with JSON.

curl -H 'Accept: application/ld+json' 'https://scigraph.springernature.com/pub.10.1007/s00402-018-3078-7'

N-Triples is a line-based linked data format ideal for batch operations.

curl -H 'Accept: application/n-triples' 'https://scigraph.springernature.com/pub.10.1007/s00402-018-3078-7'

Turtle is a human-readable linked data format.

curl -H 'Accept: text/turtle' 'https://scigraph.springernature.com/pub.10.1007/s00402-018-3078-7'

RDF/XML is a standard XML format for linked data.

curl -H 'Accept: application/rdf+xml' 'https://scigraph.springernature.com/pub.10.1007/s00402-018-3078-7'


 

This table displays all metadata directly associated to this object as RDF triples.

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42 schema:description BACKGROUND: Increased age, obesity, and American Society of Anesthesiologists (ASA) Physical Status class III and IV have been reported as predictors for mortality and perioperative complications. High-volume institutions rely on central referral services as first contact point for patients. The current study reports on a simple four-step questionnaire to identify patients with ASA-physical status class III and IV to improve referral processes and optimize perioperative work ups. MATERIALS AND METHODS: Seven hundred and seventy-five patients who called the physician referral service (PRS) at the author's institution and subsequently underwent surgery were enrolled in this study. The answers to the initial PRS questionnaire were analyzed. The study cohort consisted of 414 women (53.4%) and 361 men (46.6%) with an average age of 61.4 years (range 44-90 years) at the time of surgery. RESULTS: Binary logistic regression revealed hypertension, diabetes mellitus (using medication), using blood thinner (other than Aspirin) and a number of 4-9 prescribed medication, respectively, as predictors for ASA III and IV. Receiver-operating characteristic (ROC) curve analysis identified a sensitivity of 82.4%, a specificity of 82.9%, and an accuracy of 82.8%, when two of these four questions are answered "yes". The area under the curve for this analysis was 0.876 [95% confidence interval (CI) 0.845-0.908]. Positive and negative likelihood ratios were 4.8 (95% CI 4.0-5.8) and 0.2 (95% CI 0.1-0.3), respectively. CONCLUSIONS: This study revealed a simple four-step questionnaire to identify patients with ASA III or IV before a medical appointment. This helps to balance referrals between multiple providers in high-volume medical groups.
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