Validating the Novel Classification for the Assessment and Grading of Unexpected Events in Pediatric Surgery: The Clavien-Madadi Classification

Validation of Clavien-Madadi Classification for the Grading of Unexpected Events in Pediatric Surgery

Despite appraisal of the Clavien-Dindo classification in the pediatric surgical literature, some criticize the transfer of the grading systems for adults in a pediatric cohort without modifications. In a recent study it has been shown that few items of the classification do not offer additional information in pediatric cohorts and organizational and management errors have been integrated, not being part of the initial proposal by Dindo et al.

In a group of pediatric and general surgeons, methodologists and statisticians of the ERNICA network the Clavien-Dindo classification has been modified for the application in pediatric surgery. The aim is to test and validate the novel Clavien-Madadi classification in a pediatric surgical cohort.

Based on the protocol by Dindo et al. for the assessment of the international acceptability and reproducibility of the Clavien-Dindo classification, the aim is to circulate case scenarios (of complications/ unexpected events) within the ERNICA (European Reference Network for Rare Inherited Congenital Anomalies) network. Those case scenarios (15-20) should be graded by the respondents according to the Clavien-Dindo and Clavien-Madadi classification and preferences for future practice should be reported.

Milestones

1. All members of the working group send the PI´s 1-2 case scenarios with unexpected events in the management and treatment of neonates (preferably congenital diseases) and children for each grade of the Clavien-Madadi classification
2. All case scenarios will be circulated within the working group and will be ranked with a Likert scale (1 not accurate - 5 accurate) regarding the plausibility for an international survey
3. A final proposal of 15-20 case scenarios will be circulated within the working group
4. Circulating the case scenarios and the additional questionnaire via the ERNICA email distribution system and newsletter

Inclusion Criteria:

• Case scenarios of unexpected events
• Case scenarios on neonatal surgery
• Case scenarios on congenital malformations
• Case scenarios with (re-)interventions
• Case scenarios with organ impairment
• Case scenarios with fatal result

Exclusion Criteria:

• Complex constructed case scenarios
• Case scenarios with adult patients
• Case scenarios with multiple events