The role of the American Society of anesthesiologists physical status classification in predicting trauma mortality and outcomes

Trauma prediction scores such as Revised Trauma Score (RTS) and Trauma and Injury Severity Score (TRISS)) are used to predict mortality, but do not include comorbidities. We analyzed the American Society of Anesthesiologists physical status (ASA PS) for predicting mortality in trauma patients undergoing surgery. This multicenter, retrospective study compared the mortality predictive ability of ASA PS, RTS, Injury Severity Score (ISS), and TRISS using a complete case analysis with mixed effects logistic regression. Associations with mortality and AROC were calculated for each measure alone and tested for differences using chi-square. Of 3,042 patients, 230 (8%) died. The AROC for mortality for TRISS was 0.938 (95%CI 0.921, 0.954), RTS 0.845 (95%CI 0.815, 0.875), and ASA PS 0.886 (95%CI 0.864, 0.908). ASA PS + TRISS did not improve mortality predictive ability (p = 0.18). ASA PS was a good predictor of mortality in trauma patients, although combined with TRISS it did not improve predictive ability. •ASA PS is a good predictor of mortality in adult trauma patients.•ASA PS is a great predictor of length of stay, complications, and ventilator days.•ASA PS is not better than TRISS, alone or in combination, in predicting trauma mortality.•ASA PS performs equally to ISS and better than RTS in predicting mortality.