Clavien-Madadi Classification for Unexpected Events in Pediatric Surgery | 59 surgeons | 12 European countries | 19 case scenarios with unexpected events in a multi-staged process surgeons rate the scenarios | Clavien-Madadi vs. Clavien-Dindo | Clavien-Madadi > Clavien-Dindo | agreement rates of the respondents | (85.9% vs 76.2%; p < 0.05) | More pediatric surgeons preferred the Clavien-Madadi for the case scenarios | (43.0% vs 11.8%; p = 0.002) | Fleiss' kappa analysis showed slightly higher strength of agreement using the Clavien-Madadi classification | (0.74 vs 0.69) | Conclusion: The Clavien-Madadi classification is a precise and dependable tool for assessing unforeseen events in pediatric surgery. Therefore authors advocate for its use in both clinical and academic pediatric surgical settings. | https://pubmed.ncbi.nlm.nih.gov/38582705/ | Source: Madadi-Sanjani O et. al. | Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany | @StayCurrentMD | @EmGootee MD | Cincinnati Children's | Journal of Pediatric Surgery
Validation of the Clavien-Madadi Classification for Unexpected Events in Pediatric Surgery: A Collaborative ERNICA Project
Infographic · Sep 2024 · 1 min read
In brief
In brief
This multi-center European validation study demonstrates that the Clavien-Madadi classification outperforms the traditional Clavien-Dindo system for grading unexpected events in pediatric surgery, showing higher agreement rates (85.9% vs 76.2%) and greater accuracy for the pediatric population. The tool provides standardized assessment of surgical complications specifically adapted for children.
- Clavien-Madadi classification shows superior inter-rater agreement (85.9% vs 76.2%) compared to Clavien-Dindo for pediatric surgical complications
- Pediatric surgeons strongly prefer Clavien-Madadi over Clavien-Dindo (43.0% vs 11.8%) with 81.4% confirming its advantages for children
- Validation across 59 surgeons in 12 European countries demonstrates Clavien-Madadi is reliable (ICC 0.93) for grading pediatric adverse events
- Clavien-Madadi was considered inaccurate only 2.1% of the time versus 11.1% for Clavien-Dindo in pediatric case scenarios
- ERNICA network recommends adopting Clavien-Madadi classification as standard for reporting complications in pediatric surgical practice
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with four main sections. The top section displays the study design with a map of Europe. The middle sections show comparison statistics with a handshake illustration. The bottom features two illustrated surgeons in green scrubs and masks, followed by a yellow conclusion banner. Social media handles and journal branding appear at the bottom.
Omid Madadi-Sanjani, Joachim F Kuebler, Julia Brendel, Sara Costanzo, Anna L Granström, Emrah Aydin, Stavros Loukogeorgakis, Martin Lacher, Soeren Wiesner, Anja Domenghino, Pierre-Alain Clavien, Annika Mutanen, Simon Eaton, Benno M Ure
Background: The Clavien-Madadi classification is a novel instrument for the assessment and grading of unexpected events in pediatric surgery, based on the Clavien-Dindo classification. The system has been adjusted to better fit the pediatric population in a prospective single-center study. There is a need now to validate the Clavien-Madadi classification within an international expert network.
Methods: A pediatric surgical working group created 19 case scenarios with unexpected events in a multi-staged process. Those were circulated within the European Reference Network of Inherited and Congenital Anomalies (ERNICA) and surgeons were instructed to rate the scenarios according to the Clavien-Madadi vs. Clavien-Dindo classification.
Results: 59 surgeons from 12 European countries completed the questionnaire. Based on ratings of the case scenarios, the Clavien-Madadi classification showed significantly superior agreement rates of the respondents (85.9% vs 76.2%; p < 0.05) and was less frequently considered inaccurate for rating the pediatric population compared to Clavien-Dindo (2.1% vs 11.1%; p = 0.05). Fleiss' kappa analysis showed slightly higher strength of agreement using the Clavien-Madadi classification (0.74 vs 0.69). Additionally, intraclass correlation coefficient was slightly higher for the Clavien-Madadi compared to the Clavien-Dindo classification (ICCjust 0.93 vs 0.89; ICCunjust0.93 vs 0.89). More pediatric surgeons preferred the Clavien-Madadi classification for the case scenarios (43.0% vs 11.8%; p = 0.002) and advantages of the Clavien-Madadi were confirmed by 81.4% of the surgeons.
Conclusion: The Clavien-Madadi classification is an accurate and reliable instrument for the grading of unexpected events in pediatric surgery. We therefore recommend its application in clinical and academic pediatric surgical practice.