An adapted Clavien-Dindo scoring system in trauma as a clinically meaningful non-mortality endpoint.

Background: There is no consensus on reporting non-mortality trauma complications in a graded manner. The Clavien-Dindo scale of complications was originally for elective surgery, and requires adaptation to provide meaningful data for trauma patients. In particular the original score does not account for those treated without surgery. We report an adapted Clavien-Dindo in trauma (ACDiT) scale and apply it to patients managed operatively and non-operatively. Methods: A combined prospective and retrospective international multi-center observational study was undertaken to apply the ACDiT scale to 484 trauma patients at 3 university teaching hospitals (Birmingham, England (n=303); Houston, Texas (n=113); and Glasgow, Scotland (n=68)). These included both intensive care (ICU) and non-ICU managed patients. The Clavien-Dindo scoring system was adapted for trauma patients based on consensus amongst an international collaboration of trauma specialists at these sites. Data included whether initial patients were managed operatively or non-operatively. Complication grades were compared to hospital-free and ICU-free days as other outcome measures of patient morbidity. Results: 217/484 (44.8%) patients experienced complications, of whom 61/217 (28.1%) died (Grade V). The remainder consisted of grades I (n=20), II (n=60), III (n=24) and IV (n=52). There was a strong association between higher ACDiT grade category and lower number of hospital-free and ICU-free days (p

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