International survey-based assessment of the reliability, validity, and interpretability of the TDN grade for neurosurgical adverse events
Year: 2025
Type: article
Study design: Observational Study
Abstract: Neurosurgical adverse events (AE) are frequent and may have dramatic consequences on quality of life. The lack of a standardized classification of their severity hinders evaluation and improvement of the safety of procedures. The Therapy-Disability-Neurology (TDN) grade, validated in 2021 on 6071 interventions, overcomes limitations of previous grading-systems by addressing the severity of neurologic and disabling AEs. The aim of the current study is to assess the reliability, validity and applicability of the TDN grade. We conducted an online survey involving participants with varying levels of neurosurgical expertise. Participants assessed the TDN grade for 16 case vignettes and reviewed the validity, interpretability, logicality, simplicity, and usefulness of the grading-system. The TDN grade showed substantial inter-rater (α = 0.66) and intra-rater (α = 0.79) reliability. Most participants recommended reporting its separate dimensions, which demonstrated substantial to almost perfect reliability (inter-rater: α = 0.74; intra-rater: α = 0.85). Online calculation tools significantly improved agreement and participants' scores. The TDN grade was considered fairly useful, very logical, fairly simple to use and interpret, and its separate dimensions were considered a very valid measure of the severity of AEs. Neurosurgical AEs should be systematically reported, and surveyed neurosurgeons recommend the use of the TDN grade along its separate dimensions for this purpose.
Source: Scientific Reports
Authors: Alexis Paul Romain Terrapon, Vincens Kälin, Anna Maria Zeitlberger, Jonathan Weller, Cédric Kissling, Nicolas Neidert, Malte Mohme, Ahmed El-Garci, Tareq A. Juratli, Philip Dao Trong, Martin N. Stienen, Isabel Charlotte Hostettler, Morgan Broggi, Johannes Sarnthein, Luca Regli, Oliver Bozinov, Marian Christoph Neidert, TDN Study Group, Alexis Paul Romain Terrapon, Vincens Kälin, Anna Maria Zeitlberger, Jonathan Weller, Cédric Kissling, Nicolas Neidert, Malte Mohme, Ahmed El-Garci, Tareq A. Juratli, Philip Dao Trong, Martin N. Stienen, Isabel Charlotte Hostettler, Morgan Broggi, Johannes Sarnthein, Luca Regli, Oliver Bozinov, Marian Christoph Neidert, Erik Schulz, Francis Kissling, Jun Thorsteinsdottir, Francescco Restelli, Michael Hugelshofer, Sarah Stricker, Francesco Marchi, Anne-Katrin Hickmann, Meltem Gönel, Mukesch Johannes Shah, Veit Stoecklein, Antonia Wehn, Michal Ziga, Svenja Maschke, Michael Schmutzer-Sondergeld, Philipp Karschnia, Felix C. Stengel, Vittorio Stumpo, Max Schrammel, Marie T. Krüger, Manuel Kramer, Lorenzo Bertulli, Witold H. Polanski, Piotr Sumislawski, Tobias Greve, Frederic Thiele, Daniel Hoffmann Ayala, Biyan Nathanael Harapan, Sebastian Siller, Ulrich Hubbe, Arian Karbe, Sven Richter, Schirin Hunziker, Christian V. Eisenring, Emanuele La Corte, André N. J. Sagerer, Katharina Janosovits, Costanza Maria Zattra, Manou Overstijns, David M. Hasan, Jacopo Falco, Sivani Sivanrupan, Emanuele Rubiu, Stefanie Ott, Menno Germans, Christoph Scholz, Richard Drexler, Diederik Bulters, Christine Steiert, Florian Volz, Alice Senta Ryba, Soham Bandyopadhyay, Chibueze Agwu, Gregor Fischer, Markus Florian Oertel, Luis Padevit, Oliver Bichsel, Alexandra Grob, Victor E. Staartjes, Elisa Colombo, Alexander Hoyningen
Institutions: University of Bern, Kantonsspital St. Gallen, University Hospital of Bern, LMU Klinikum, Ludwig-Maximilians-Universität München, University of Freiburg, University Medical Center Freiburg, University Medical Center Hamburg-Eppendorf, Carl von Ossietzky Universität Oldenburg, Evangelisches Krankenhaus Oldenburg, Charité - Universitätsmedizin Berlin, University Hospital Carl Gustav Carus, Technische Universität Dresden, University Hospital Heidelberg, TUM Klinikum, Technical University of Munich, Fondazione IRCCS Istituto Neurologico Carlo Besta, University of Zurich, University Hospital Zurich, Ente Ospedaliero Cantonale, Luzerner Kantonsspital, National Hospital for Neurology and Neurosurgery, University of Bologna, University of Brescia, Duke University, Duke Medical Center, University Hospital Southampton NHS Foundation Trust, University of Chicago
Language: English
Subfield: Emergency Medical Services
Field: Health Professions
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,690
OpenAlex ID: W4415620160