Validation of the Clavien-Madadi Classification for Unexpected Events in Pediatric Surgery: A Collaborative ERNICA Project
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Omid Madadi-Sanjani, Joachim F. Kuebler, Julia Brendela, Sara Costanzod, Anna L. Granströmc, Emrah Aydin, Stavros Loukogeorgakish, 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; ICCunjust 0.93 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.
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Is the Clavian Madati classification a valid tool for grading unexpected events in pediatric surgery? I'm Alex Halpern, a research fellow from Children's National, and this is an article that you should know. To attempt to validate this instrument, a working group of pediatric surgeons from Europe created 19 case scenarios. With unexpected events, they then circulated these scenarios within the European Reference Network of inherited and congenital anomalies, and surgeons rated the scenarios based on the Clavian Dindo classification or the Clavian Madadi classification. A total of 59 surgeons completed the questionnaire. The Clavian-Matti classification showed significantly better agreement rates and was less frequently considered inaccurate. More pediatric surgeons preferred using the Clavian-Matti classification. So it seems like the Clavian-Matti classification is both an accurate and useful tool in grading unexpected events in pediatric surgery. Will you start using this classification in your own practice? Let us know what you think in the comments below.