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. 2022 Dec 20;38(4):391-400.
doi: 10.47717/turkjsurg.2022.5793. eCollection 2022 Dec.

Validation of the adapted clavien dindo in trauma (ACDiT) scale to grade management related complications at a level I trauma center

Niladri Banerjee  1 , Dinesh Bagaria  2 , Harshit Agarwal  3 , Anand Kumar Katiyar  4 , Subodh Kumar  2 , Sushma Sagar  2 , Biplab Mishra  2 , Amit Gupta  2
Affiliations

Validation of the adapted clavien dindo in trauma (ACDiT) scale to grade management related complications at a level I trauma center

Niladri Banerjee et al. Turk J Surg. .

Abstract

Objectives: 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; outcome assessment; quality improvement; trauma.

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Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Comparison of Hospital free days (A) and ICU free days (B) across ACDiT grades (Horizontal bars represent median values; upper and lower boundaries of boxes represent the 25th to 75th percentiles (i.e., IQR); whiskers represent 10th to 90th percentiles; circles represent outliers). Statistical significance using Tukey’s multiple comparison of means is illustrated using *p< 0.05, **p< 0.01, ***p< 0.001.
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