PMID- 30036291
OWN - NLM
STAT- MEDLINE
DCOM- 20181211
LR  - 20191210
IS  - 1539-2570 (Electronic)
IS  - 0271-6798 (Print)
IS  - 0271-6798 (Linking)
VI  - 38
IP  - 10
DP  - 2018 Nov/Dec
TI  - Classifying Adverse Events Following Lower Limb Orthopaedic Surgery in Children 
      With Cerebral Palsy: Reliability of the Modified Clavien-Dindo System.
PG  - e604-e609
LID - 10.1097/BPO.0000000000001233 [doi]
AB  - BACKGROUND: The modified Clavien-Dindo (MCD) system is a reliable tool for 
      classifying adverse events (AEs) in hip preservation surgery and has since been 
      utilized in studies involving lower limb surgery for ambulant and nonambulant 
      children with cerebral palsy (CP). However, the profile of AEs recorded in 
      children with CP compared with typically developing children is different, and 
      the reliability of the MCD in CP is unknown. This study aimed to evaluate the 
      interrater and intrarater reliability of the MCD system for classifying AEs 
      following lower limb surgery in children with CP. METHODS: Eighteen raters were 
      invited to participate, including clinicians from surgical, nursing, and physical 
      therapy professions, and individuals with CP. Following a MCD familiarization 
      session, participants rated 40 clinical scenarios on 2 occasions, 2 weeks apart. 
      Fleiss' kappa statistics were used to calculate interrater and intrarater 
      reliability. RESULTS: The overall Fleiss' kappa value for interrater reliability in 
      the first rating was 0.70 (95% confidence interval, 0.61-0.80), and increased to 
      0.75 (95% confidence interval, 0.66-0.84) in the second rating. The average 
      Fleiss' kappa value for intrarater reliability was 0.78 (range, 0.48 to 1.00). 
      Grading of more severe AEs (MCD III to V) achieved near perfect agreement (kappa, 
      0.87 to 1.00). There was a lower level of agreement for minor AEs (MCD I-II) (kappa, 
      0.53 to 0.55). A kappa score of 0 to 0.2 was deemed as poor, 0.21 to 0.4 as fair, 
      0.41 to 0.6 as good, 0.61 to 0.8 as very good, and 0.81 to 1.0 as almost perfect 
      agreement. CONCLUSIONS: The MCD System demonstrates a very good interrater and 
      intrarater reliability following lower limb surgery in children with CP. The MCD 
      can be used by clinicians from different health care professions with a high 
      level of reliability. The MCD may improve standardization of AE recording with a 
      view to accurate audits and improved clarity in outcome studies for CP. LEVEL OF 
      EVIDENCE: Level II-diagnostic.
FAU - Zhou, Leena
AU  - Zhou L
AD  - Department of Orthopaedics.
AD  - Department of Paediatrics, University of Melbourne.
FAU - Willoughby, Kate
AU  - Willoughby K
AD  - Department of Orthopaedics.
AD  - Centre of Research Excellence in Cerebral Palsy, Murdoch Children's Research 
      Institute, Parkville, Vic.
FAU - Strobel, Natalie
AU  - Strobel N
AD  - Faculty of Health and Medical Sciences, The University of Western Australia, 
      Crawley, WA.
FAU - Thomason, Pam
AU  - Thomason P
AD  - Hugh Williamson Gait Laboratory, The Royal Children's Hospital.
FAU - Gallagher, Charles
AU  - Gallagher C
AD  - Department of Orthopaedics.
FAU - Harambasic, Mela
AU  - Harambasic M
AD  - Department of Orthopaedics.
FAU - Khot, Abhay
AU  - Khot A
AD  - Department of Orthopaedics.
AD  - Department of Paediatrics, University of Melbourne.
FAU - Graham, H Kerr
AU  - Graham HK
AD  - Department of Orthopaedics.
AD  - Department of Paediatrics, University of Melbourne.
AD  - Centre of Research Excellence in Cerebral Palsy, Murdoch Children's Research 
      Institute, Parkville, Vic.
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PL  - United States
TA  - J Pediatr Orthop
JT  - Journal of pediatric orthopedics
JID - 8109053
SB  - IM
MH  - Cerebral Palsy/*complications
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Humans
MH  - Lower Extremity/*surgery
MH  - Male
MH  - Observer Variation
MH  - Orthopedic Procedures/*adverse effects
MH  - Orthopedics/*standards
MH  - Outcome Assessment, Health Care
MH  - Reproducibility of Results
PMC - PMC6211781
COIS- H.K.G. is a member of the OrthoPediatrics Surgeons Advisory Board. H.K.G. and 
      K.W. are supported by the National Health and Medical Research Council (NHMRC) 
      Centre of Research Excellence in Cerebral Palsy (CRE-CP). The remaining authors 
      declare no conflicts of interest.
EDAT- 2018/07/24 06:00
MHDA- 2018/12/12 06:00
PMCR- 2018/11/01
CRDT- 2018/07/24 06:00
PHST- 2018/07/24 06:00 [pubmed]
PHST- 2018/12/12 06:00 [medline]
PHST- 2018/07/24 06:00 [entrez]
PHST- 2018/11/01 00:00 [pmc-release]
AID - 10.1097/BPO.0000000000001233 [doi]
PST - ppublish
SO  - J Pediatr Orthop. 2018 Nov/Dec;38(10):e604-e609. doi: 
      10.1097/BPO.0000000000001233.