International survey-based assessment of the reliability, validity, and interpretability of the TDN grade for neurosurgical adverse events

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.

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Publication Details

Journal
Scientific Reports
Published
2025-10-28
DOI
https://doi.org/10.1038/s41598-025-21065-8
Citations
1
Primary Topic
Patient Safety and Medication Errors
Type
article
Field-Weighted Citation Impact
2.52
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article

International survey-based assessment of the reliability, validity, and interpretability of the TDN grade for neurosurgical adverse events

Michael Hugelshofer, Markus F. Oertel, Oliver Bichsel, David Hasan et al.
1 citations
Scientific Reports
Patient Safety and Medication Errors
2.52
article

International survey-based assessment of the reliability, validity, and interpretability of the TDN grade for neurosurgical adverse events

Michael Hugelshofer, Markus F. Oertel, Oliver Bichsel, David Hasan, Emanuele Rubiu, Philip Dao Trong, Max Schrammel, Ahmed El-Garci, Anne‐Katrin Hickmann, Meltem Gönel, Antonia Wehn, Tobias Greve, Francesco Restelli, Jacopo Falco, Felix C. Stengel, Jonathan Weller, Elisa Colombo, Nicolas Neidert, Isabel C. Hostettler, Victor E. Staartjes, Jun Thorsteinsdottir, Christine Steiert, Arian Karbe, Cédric Kissling, Manuel Kramer, Anna Maria Zeitlberger, Philipp Karschnia, Sivani Sivanrupan, Svenja Maschke, Michael Schmutzer-Sondergeld, André Sagerer, Sebastian Siller, Marian Christoph Neidert, Gregor Fischer, Manou Overstijns, Michal Ziga, Emanuele La Corte, Marie T. Krüger, Oliver Bozinov, Menno R. Germans, Alexis Paul Romain Terrapon, Diederik Bulters, Luis Padevit, Vincens Kälin, Luca Regli, Florian Volz, Alice Ryba, Schirin Hunziker, Costanza Maria Zattra, Malte Mohme, Veit M. Stoecklein, Chibueze Agwu, Sarah Stricker, Frederic Thiele, Lorenzo Bertulli, Martin N. Stienen, Soham Bandyopadhyay, Tareq Adnan Juratli, Alexander Hoyningen, Mukesch Johannes Shah, Erik Schulz, Vittorio Stumpo, Alexandra Grob, Richard Drexler, Johannes Sarnthein, Morgan Broggi, Biyan Nathanael Harapan, Christian Eisenring, Katharina Janosovits, Francis Kissling, F Marchi, Christoph Scholz, Sven Richter, Stefanie Ott, Witold Henryk Polanski, Ulrich Hubbe, Piotr Sumislawski, Daniel Hoffmann Ayala
article en
1 citations

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.

Scientific ReportsVol. 15(1)
Universität Hamburg (DE), University of Freiburg (DE), University of St.Gallen (CH), Heidelberg University (DE), University Hospital of Bern (CH), University Medical Center Freiburg (DE), Southampton General Hospital (GB), University Hospital Heidelberg (DE), TUM Klinikum (DE), LMU Klinikum (DE), University of Chicago (US), Ente Ospedaliero Cantonale (CH), University Hospital of Zurich (CH), Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT), University Medical Center Hamburg-Eppendorf (DE), Luzerner Kantonsspital (CH), Duke Medical Center (US), Evangelisches Krankenhaus Oldenburg (DE), National Hospital for Neurology and Neurosurgery (GB), University Hospital Carl Gustav Carus (DE), Fondazione IRCCS Istituto Neurologico Carlo Besta (IT), Ostschweizer Kinderspital (CH), University College London (GB), Charité - Universitätsmedizin Berlin (DE), University of Brescia (IT), Ludwig-Maximilians-Universität München (DE), Praxis (EE), University of Bologna (IT)
Openalex Percentile: Top 9%
Patient Safety and Medication Errors
2.52
DOIOpen Access PDFOpenAlex
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