Validation of the adapted clavien dindo in trauma (ACDiT) scale to grade management related complications at a level I trauma center
Niladri Banerjee1
, Dinesh Bagaria2, Harshit Agarwal3, Anand Kumar Katiyar4, Subodh Kumar2, Sushma Sagar2, Biplab Mishra2, Amit Gupta2
1Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, India
2Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
3Department of Trauma and Emergency, All India Institute of Medical Sciences, Rae Bareli, India
4 Department of Surgery, Command Hospital (Northern Command), Udhampur, India
Abstract
Objective: Complications during trauma management are the main factor responsible for the overall increase in treatment cost. There are very few grading systems to measure the burden of complications in trauma patients. A prospective study was conducted using the Adapted Clavien Dindo in Trauma (ACDiT) scale, with the primary aim of validating it at our center. As a secondary aim, it was also wanted to measure the mortality burden among our admitted patients.
Material and Methods: The study was conducted at a dedicated trauma center. All patients with acute injuries, who were admitted, were included. An initial treatment plan was made within 24 hours of admission. Any deviation from this was recorded and graded according to the ACDiT. The grading was correlated with hospital-free days and ICU-free days within 30 days.
Results: A total of 505 patients were included in this study, with a mean age of 31 years. The most common mechanism of injury was road traffic injury, with a median ISS and NISS of 13 and 14, respectively. Two hundred and forty-eight out of 505 patients had some grade of complication as determined by the ACDiT scale. Hospital-free days (13.5 vs. 25; p< 0.001) were significantly lower in patients with complications than those without complications, and so were ICU-free days (29 vs. 30; p< 0.001). Significant differences were also observed when comparing mean hospital free and ICU free days across various ACDiT grades. Overall mortality of the population was 8.3 %, the majority of whom were hypotensive on arrival and required ICU care.
Conclusion: We successfully validated the ACDiT scale at our center. We recommend using this scale to objectively measure in-hospital complications and improve trauma management quality. ACDiT scale should be one of the data points in any trauma database/registry.
Keywords: Morbidity, trauma, quality improvement, outcome assessment
Cite this article as: Banerjee N, Bagaria D, Agarwal H, Katiyar AK, Kumar S, Sagar S, et al. Validation of the adapted clavien dindo in trauma (ACDiT) scale to grade management related complications at a level I trauma center. Turk J Surg 2022; 38 (4): 391-400.
This study was approved by All India Institute of Medical Sciences Ethics Committee for Post Graduate Research (Ref. no: IECPG-458/29.11.2017, Date: 05.12.2017).
Externally peer-reviewed.
Concept – All of authors; Design – All of authors; Supervision – All of authors; Data Collection and/ or Processing – NB, DB, HA, AKK; Analysis and/or Interpretation – NB, DB, AG, BM; Literature Search – NB, HA, BM, AG; Writing Manuscript – NB, DB, HA, SK, AG; Critical Reviews – NB, DB, SK, SS, BM, AKK.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.