ArticleJB & JS open access2018
Reliability of the Modified Clavien-Dindo-Sink Complication Classification System in Pediatric Orthopaedic Surgery.
Article in JB & JS open access, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06519175 (Observational Retrospective and Prospective Study of Infantile Lower Limb Malformations and Deformities), which is not on this map. Cited by 57 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Observational Retrospective and Prospective Study of Infantile Lower Limb Malformations and Deformities
Who cites it
57 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Gastrocsoleus lengthening in combination with tibialis anterior tendon shortening for equinus deformity in children with cerebral palsy: a systematic review.Systematic reviews · 2025Pooled it
- Pooled it
- Predictors for postoperative gastrointestinal complications in pediatric non-idiopathic scoliosis patients.Spine deformity · 2026Article
- Complications and unplanned return to the operating room (UPROR) at five years post-operative vertebral body tethering for idiopathic scoliosis.Spine deformity · 2026Article
- Fibrous dysplasia: clinical and pathologic characteristics, surgical approaches, and outcomes in a large Italian cohort.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2026Article
- Short term-outcomes of periacetabular osteotomy in the neuromuscular hip.Journal of hip preservation surgery · 2026Article
- Gender differences in early functional recovery after minimally invasive distal transverse metatarsal osteotomy - Akin Osteotomy (MITA) for hallux valgus: a propensity-matched study of 300 cases.BMC musculoskeletal disorders · 2026Article
- Treatment and outcomes of fractures in children: a registry-based cohort study of 10,144 fractures.Acta orthopaedica · 2026Article
- K-wire shows striking advantages to plateosteosynthesis for distal metaphyseal radius fracture in children: a retrospective, two-center study.Journal of orthopaedic surgery and research · 2026Article
- Complications Leading to Reoperation After Pediatric Tibial Spine Fracture Fixation.Orthopaedic journal of sports medicine · 2026Article
- Identifying patients at risk in revision arthroplasty: a comprehensive single-centre analysis.Journal of orthopaedic surgery and research · 2026Article
- Development of a simple clinical score to estimate in-hospital adverse event risk after elective hip arthroplasty: a retrospective cohort study in a high-risk population.Archives of orthopaedic and trauma surgery · 2025Article
- Outcomes and Complications for Minimally Invasive Distal Transverse Metatarsal Osteotomy-Akin Osteotomy (MITA) for Hallux Valgus: 493 Cases.Journal of orthopaedic surgery and research · 2025Article
- How to minimize complications during and after periacetabular osteotomy : lessons learned from over 700 patients with and without concomitant hip arthroscopy.Bone & joint open · 2025Article
- Determinants of Surgical Response to Lateral Tibial Hemiepiphysiodesis in Idiopathic and Non-Idiopathic Genu Varum: Real-World Evidence from a Tertiary Pediatric Cohort.Journal of clinical medicine · 2025Article
- Only Minor Complications Are Reported After Needle Arthroscopy: A Systematic Review.Arthroscopy, sports medicine, and rehabilitation · 2025Review
- Comparison of Three Surgical Options for Treatment of Diaphyseal Tibia Fractures in Pediatric Patients.Journal of the Pediatric Orthopaedic Society of North America · 2025Article
- Plate and K-Wire Show Advantages to Nailing for Distal Diametaphyseal Radius Fracture in Children: A Retrospective, Two-Center Study.Journal of clinical medicine · 2025Article
- Complications of Reamer-Irrigator-Aspirator System in Pediatric Orthopedic Surgery-Case Series and Scoping Review.Children (Basel, Switzerland) · 2025Review
- The risk of complications in elective orthopedic surgeries in children and young adults with cerebral palsy: a population-based register study.Acta orthopaedica · 2025Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere is no standardized complication classification system that has been evaluated for use in pediatric or general orthopaedic surgery. Instead, subjective terms such as
methodsThe Clavien-Dindo-Sink complication classification system was modified for use with general orthopaedic procedures. Forty-five pediatric orthopaedic surgical scenarios were presented to 7 local fellowship-trained pediatric orthopaedic surgeons at 1 center to test internal reliability, and 48 scenarios were then presented to 15 pediatric orthopaedic surgeons across the United States and Canada to test external reliability. Surgeons were trained to use the system and graded the scenarios in a random order on 2 occasions. Fleiss and Cohen kappa (κ) statistics were used to determine interrater and intrarater reliabilities, respectively.
resultsThe Fleiss κ value for interrater reliability (and standard error) was 0.76 ± 0.01 (p < 0.0001) and 0.74 ± 0.01 (p < 0.0001) for the internal and external groups, respectively. For each grade, interrater reliability was good to excellent for both groups, with an overall range of 0.53 for Grade I to 1 for Grade V. The Cohen κ value for intrarater reliability was excellent for both groups, ranging from 0.83 (95% confidence interval [CI], 0.71 to 0.95) to 0.98 (95% CI, 0.94 to 1.00) for the internal test group and from 0.83 (95% CI, 0.73 to 0.93) to 0.99 (95% CI, 0.97 to 1.00) for the external test group.
conclusionsThe modified Clavien-Dindo-Sink classification system has good interrater and excellent intrarater reliability for the evaluation of complications following pediatric orthopaedic upper extremity, lower extremity, and spine surgery. Adoption of this reproducible, reliable system as a standard of reporting complications in pediatric orthopaedic surgery, and other orthopaedic subspecialties, could be a valuable tool for improving surgical practices and patient outcomes.
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Registered trials
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