Validation of the Clavien-Madadi Classification for Unexpected Events in Pediatric Surgery: A Collaborative ERNICA...

Area of Science:

• Pediatric Surgery
• Surgical Complications
• Medical Classification Systems

Background:

• The Clavien-Madadi classification is a novel system for assessing unexpected events in pediatric surgery, adapted from the Clavien-Dindo classification.
• Previous single-center studies adjusted the system for pediatric populations, highlighting the need for international validation.

Purpose of the Study:

• To validate the international applicability and reliability of the Clavien-Madadi classification for pediatric surgical complications.
• To compare the performance of the Clavien-Madadi classification against the established Clavien-Dindo classification in a diverse group of pediatric surgeons.

Main Methods:

• A working group developed 19 case scenarios involving unexpected surgical events.
• These scenarios were circulated among surgeons in the European Reference Network of Inherited and Congenital Anomalies (ERNICA) for rating using both classification systems.

Main Results:

• 59 surgeons from 12 European countries participated, with Clavien-Madadi showing significantly higher agreement rates (85.9% vs. 76.2%) and lower perceived inaccuracy (2.1% vs. 11.1%).
• Fleiss' kappa and intraclass correlation coefficients indicated a slightly stronger agreement with Clavien-Madadi (kappa 0.74 vs. 0.69; ICC 0.93 vs. 0.89).
• A majority of surgeons preferred Clavien-Madadi (43.0% vs. 11.8%) and confirmed its advantages (81.4%).

Conclusions:

• The Clavien-Madadi classification demonstrates accuracy and reliability for grading unexpected events in pediatric surgery.
• The study recommends the adoption of the Clavien-Madadi classification in both clinical and academic pediatric surgical settings.