An adapted Clavien-Dindo scoring system in trauma as a clinically meaningful nonmortality endpoint

Abstract

Background There is no consensus on reporting non-mortality trauma complications in a graded manner. The Clavien-Dindo scale of complications was originally for elective surgery, and requires adaptation to provide meaningful data for trauma patients. In particular the original score does not account for those treated without surgery. We report an adapted Clavien-Dindo in trauma (ACDiT) scale and apply it to patients managed operatively and non-operatively. Methods A combined prospective and retrospective international multi-center observational study was undertaken to apply the ACDiT scale to 484 trauma patients at 3 university teaching hospitals (Birmingham, England (n=303); Houston, Texas (n=113); and Glasgow, Scotland (n=68)). These included both intensive care (ICU) and non-ICU managed patients. The Clavien-Dindo scoring system was adapted for trauma patients based on consensus amongst an international collaboration of trauma specialists at these sites. Data included whether initial patients were managed operatively or non-operatively. Complication grades were compared to hospital-free and ICU-free days as other outcome measures of patient morbidity. Results 217/484 (44.8%) patients experienced complications, of whom 61/217 (28.1%) died (Grade V). The remainder consisted of grades I (n=20), II (n=60), III (n=24) and IV (n=52). There was a strong association between higher ACDiT grade category and lower number of hospital-free and ICU-free days (p<0.01). Eighty-eight patients with complications did not require surgery, validating the score’s usefulness in patients managed non-operatively. Conclusions The ACDiT scale can be used to grade the severity of post-trauma complications in patients managed both operatively and non-operatively. It provides clinically meaningful data for morbidity and mortality meetings and other quality improvement exercises.

Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients

“…Other specializations apart from general surgery have consecutively implemented this classification for their own surgical catalogues. For example, Naumann and collaborators brought traumatologists from three centers together to adapt the classification to their needs under the name of Adapted Clavien-Dindo in Trauma (ACDiT), thus being able to classify both surgically and conservatively treated patients [ 9 ]. The Division of Plastic Surgery, Medical University of Graz, used the classification to assess their elective reduction mammoplasties in a large retrospective cohort [ 10 ].…”

The Implementation of a Complication Avoidance Care Bundle Significantly Reduces Adverse Surgical Outcomes in Orthopedic Trauma Patients

“…Scoring tools, such as the Clavien–Dindo scale system or the Comprehensive Complication Index (CCI) have been developed to provide clinically meaningful data on the severity of the complications [ 10 , 11 ]. For trauma patients, the Clavien–Dindo complication scoring system has even been adapted to grade the severity of post-traumatic complications in patients managed surgically and nonsurgically [ 12 ]. These scoring systems are increasingly used as nonmortality endpoints for research purposes, but also for quality improvement measures such as Morbidity and Mortality (M&M) conferences.…”

Multi-Modal Analgesic Strategy for Trauma: A Pragmatic Randomized Clinical Trial

“…Additional secondary outcomes included the incidence of opioid-related complications (eg ileus, unplanned intubation, unplanned admission to an ICU, and use of an opioid-reversal agent), complications graded using the adapted Clavien-Dindo in trauma (ACDiT) scale, and lengths of stay (ie hospital, ICU, and ventilator days). 11 The ACDiT is a standardized method to grade the severity of complications after injury. It evaluates complications on a scale ranging from 0 to 5, with 0 indicating no complications and 5 indicating death.…”