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. 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. 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 (ICC 0.93 vs 0.89; ICC 0.93 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. 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. III.

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小儿外科意外事件 Clavien-Madadi 分类的验证：ERNICA 合作项目

Clavien-Madadi 分类是一种基于 Clavien-Dindo 分类的新型工具，用于评估和分级小儿外科意外事件。该系统已经过调整，以更好地适应前瞻性单中心研究中的儿科人群。现在需要在国际专家网络内验证 Clavien-Madadi 分类。一个小儿外科工作组在多阶段过程中创建了 19 个发生意外事件的病例场景。这些数据在欧洲遗传和先天性异常参考网络 (ERNICA) 内流传，并指示外科医生根据 Clavien-Madadi 与 Clavien-Dindo 分类对场景进行评级。来自 12 个欧洲国家的 59 名外科医生完成了调查问卷。根据病例场景的评级，Clavien-Madadi 分类显示受访者的同意率显着较高（85.9% 对比 76.2%；p < 0.05），并且与 Clavien-Dindo 分类（2.1 % vs 11.1%；p = 0.05）。 Fleiss 的 kappa 分析显示，使用 Clavien-Madadi 分类的一致性强度稍高（0.74 比 0.69）。此外，与 Clavien-Dindo 分类相比，Clavien-Madadi 分类的组内相关系数略高（ICC 0.93 vs 0.89；ICC 0.93 vs 0.89）。更多的儿科外科医生在病例场景中更喜欢 Clavien-Madadi 分类（43.0% vs 11.8%；p = 0.002），并且 81.4% 的外科医生确认了 Clavien-Madadi 的优势。 Clavien-Madadi 分类是一种准确可靠的工具，用于对小儿外科意外事件进行分级。因此，我们建议将其应用于临床和学术小儿外科实践。三．