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

Infographic · Sep 2024 · 1 min read

In brief

Multi-center European validation study demonstrates the Clavien-Madadi classification outperforms the adult-focused Clavien-Dindo system for grading unexpected events in pediatric surgery, with higher agreement rates (85.9% vs 76.2%) and surgeon preference. The pediatric-specific adaptation shows superior reliability and accuracy for assessing surgical complications in children.

Clavien-Madadi classification showed superior agreement rates vs Clavien-Dindo for pediatric surgical complications (85.9% vs 76.2%, p<0.05)
59 European surgeons validated the system across 19 case scenarios, with 81.4% confirming advantages over adult-focused Clavien-Dindo
Pediatric-specific modifications reduced inaccuracy rates from 11.1% to 2.1% when grading unexpected events in children
Interrater reliability was excellent for both systems but slightly higher with Clavien-Madadi (ICC 0.93 vs 0.89)
ERNICA network recommends adopting Clavien-Madadi for standardized complication reporting in pediatric surgery research and practice

Written by the GCMD Library team from the infographic.

A three-column comparison layout with icons representing different surgical procedures. Each column contains graphical elements showing success percentages, with POEM on the right displaying the highest rate at 99%. Color-coded bars or circles likely indicate comparative outcomes across the three treatment modalities.

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.

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