Table 5 Inter-rater Reliability Testing of Form 3

1

Do you have any allergies (to medicines, sticking plaster, iodine, latex, food, etc.)?

97

Good

2

As medicines and supplements can affect body functions and interact with anaesthetics, please list all the medicines (including traditional medicines and health supplements) you are currently taking on a regular or daily basis in the last 2 weeks. ^b

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3

Have you ever had an operation (including major dental surgery e.g. wisdom teeth extraction)?

89

Poor

4

Are you ever short of breath after walking up two flights of stairs or an overhead bridge?

76

Poor

5

Have you ever had an ECG (or electrocardiogram) and been told it was not normal?

86

Poor

6

Has a doctor ever told you, you have high blood pressure, also known as ‘hypertension’?

95

Good

7

Do you have, or have you ever had chest pain that you felt tight or heavy (not from coughing)?

91

Moderate

8

Have you ever had a heart attack?

100

Good

9

Do you have frequent swelling in both feet or both ankles?

92

Moderate

10

Do you have, or have you ever had treatment for problems with your heartbeat (too low, too fast, irregular)?

97

Good

11

Has a doctor ever told you they heard an abnormal sound (e.g. a click or a murmur) whilst listening to your heart?

97

Good

12

Do you have a cardiac pacemaker or an implanted cardioverter-defibrillator?

98

Good

13

Have you ever had heart surgery (valve or stent or bypass operation)?

100

Good

14

Do you have or have you ever had blood clots in legs or lungs?

98

Good

15

Have you ever had a blood transfusion?

100

Good

16

Do you have asthma or have you had asthma as a child?

95

Good

17

Do you currently have a cough lasting more than 8 weeks?

97

Good

18

Do you have a long-term lung disease (such as chronic bronchitis or chronic obstructive pulmonary disease)?

99

Good

19

Has anyone told you that you stop breathing of choke during your sleep – a condition also known as sleep apnoea?

99

Good

20

Have you been told that you snore so loud you keep others awake while you are asleep?

90

Moderate

21

Do you often feel tired, fatigued or sleepy during the daytime (tired enough that you could fall asleep while performing activities e.g. driving, waking, texting)?

96

Good

22

Do you smoke or have you ever smoked?

90

Moderate

23

Do you have gastric reflux or heartburn?

80

Poor

24

Do you have or have you ever had liver problems (such as hepatitis or cirrhosis)?

97

Good

25

How many days a week do you drink alcohol (on average)? ^b

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–

26

Do you have or have you ever had abnormal kidney function or kidney disease?

100

Good

27

Have you ever had a (minor) stroke or a brain bleed?

100

Good

28

Do you have or have you ever had fits/seizures/epilepsy?

100

Good

29

Have you ever lost consciousness?

98

Good

30

Do you have or have you ever had diabetes or diabetes related to pregnancy?

98

Good

31

Do you have or have you ever had thyroid problems (e.g. thyroid hormone levels being too high or too low or having an enlarged thyroid)?

95

Good

32

Do you have loose/chipped teeth, crowns, bridges, veneers or dentures?

91

Moderate

33

Do you have difficulty swallowing?

97

Good

34

Do you have difficulty opening your mouth wide?

98

Good

35

Do you have or have you ever had pain or stiffness in the lower back, neck or jaw?

81

Poor

36

Have you ever been told that you have had problems with anaesthetics in a previous operation, such as an abnormal reaction to anaesthesia or allergy to anaesthetics?

94

Moderate

37

Has any of your blood relatives ever had problems with anaesthetics in a previous operation?

91

Moderate

38

Do you have or have you ever had anxiety, depression or other emotional/psychiatric disorders?

94

Moderate

39

Do you have any other medical information that we should know about?

83

Poor