ASA Classification

[camkiss]

How do you guys rate ASA classification in trauma patients?

If a totally healthy 21 year old comes in with a ruptured spleen, IVC tear, etc. etc. from a MVC, is he a I-E or a IV-E?

Outside of trauma, the classification makes sense to me.

Thanks,
camkiss
CA-1

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[jetproppilot]

How do you guys rate ASA classification in trauma patients?

If a totally healthy 21 year old comes in with a ruptured spleen, IVC tear, etc. etc. from a MVC, is he a I-E or a IV-E?

Outside of trauma, the classification makes sense to me.

Thanks,
camkiss
CA-1

Good question, Cam.

In my book, if the dude PRESENTS to me in critical condition, regardless of his previous healthy condition, he's a 4-E.

 

[mountaindew2006]

Good question, Cam.

In my book, if the dude PRESENTS to me in critical condition, regardless of his previous healthy condition, he's a 4-E.

sound reasoning to me

 

[Noyac]

Good question, Cam.

In my book, if the dude PRESENTS to me in critical condition, regardless of his previous healthy condition, he's a 4-E.

Agree. If you don't do anything, he is dead therefore, ASA 4
Emergency, cause its got to go now.

But it doesn't really matter cause insurance (if I remember right) will only pay for one or the other (ASA3 or >, or emergency case) not both. So for us its an emergency.

 

[militarymd]

The ASA classification doesn't really apply to trauma if you read the definition.

 

[VolatileAgent]

agreed. the ASA classification is almost completely worthless, imho, especially in trauma. in general, there is a lot of interevaluator AND intraevaluator variability (and studies have repeatedly demonstrated this).

ASA classification has to do solely with the patient's background and underlying physical status and pre-morbid condition. for example, an otherwise healthy 25-year-old with a huge isolated tumor in their belly coming in for removal is still an ASA 1 if they do not have any other functional limitations based upon their physiology. if they are, otoh, a 25-year-old with DM1, HTN, severe CHF, and severe persistent asthma coming in for a bunionectomy under regional and MAC, they'd be an ASA 4 in my book.

the ASA classification is intended to provide a predictive value in the likelihood that a patient will suffer morbidity/mortality secondary to the anesthetic. nothing more. and, imho, it is so woefully misunderstood and misused by ancillary staff, and even many anesthesia attendings, that it is of little value. i mean, what's the real difference between an ASA 2 with an acute exacerbation and a stable ASA 3? as near as i can tell, no study has been able to answer that question either.

 

[jwk]

agreed. the ASA classification is almost completely worthless, imho, especially in trauma. in general, there is a lot of interevaluator AND intraevaluator variability (and studies have repeatedly demonstrated this).

ASA classification has to do solely with the patient's background and underlying physical status and pre-morbid condition. for example, an otherwise healthy 25-year-old with a huge isolated tumor in their belly coming in for removal is still an ASA 1 if they do not have any other functional limitations based upon their physiology. if they are, otoh, a 25-year-old with DM1, HTN, severe CHF, and severe persistent asthma coming in for a bunionectomy under regional and MAC, they'd be an ASA 4 in my book.

the ASA classification is intended to provide a predictive value in the likelihood that a patient will suffer morbidity/mortality secondary to the anesthetic. nothing more. and, imho, it is so woefully misunderstood and misused by ancillary staff, and even many anesthesia attendings, that it is of little value. i mean, what's the real difference between an ASA 2 with an acute exacerbation and a stable ASA 3? as near as i can tell, no study has been able to answer that question either.

I agree philosophically, but someone who comes in with a transected aorta gets a 5E - let the friggin insurance company figure it out. And what about ASA 6? We have plenty of perfectly healthy individuals who are organ donors following their head trauma.

 

[Noyac]

I agree philosophically, but someone who comes in with a transected aorta gets a 5E - let the friggin insurance company figure it out. And what about ASA 6? We have plenty of perfectly healthy individuals who are organ donors following their head trauma.

ASA 5 in my opinion is someone who will die from the injury in some recent time frame, like 24 hrs.
I have had 2 transected aorta survive. They were on the same day (new years) and both were uner circ arrest. Therefore, I make them a ASA 4 until I am sure that they are going to die. Just my thoughts on the subject. I think it is a poor system overall.

 

[bubalus]

P1 A normal healthy patient

P2 A patient with mild systemic disease

P3 A patient with severe systemic disease

P4 A patient with severe systemic disease that is a constant threat to life

P5 A moribund patient who is not expected to survive without the operation

P6 A declared brain-dead patient whose organs are being removed for donor purposes

A transected aorta gets a 5 in my book as you really can't expect them to survive without the operation.