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

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • TDN Study Group - (Author)
  • Alexis Paul Romain Terrapon - , Cantonal Hospital St. Gallen, University of Bern (Author)
  • Vincens Kälin - , Cantonal Hospital St. Gallen (Author)
  • Anna Maria Zeitlberger - , Cantonal Hospital St. Gallen (Author)
  • Jonathan Weller - , Ludwig Maximilian University of Munich (Author)
  • Cédric Kissling - , University of Bern (Author)
  • Nicolas Neidert - , University Medical Center Freiburg (Author)
  • Malte Mohme - , University of Hamburg (Author)
  • Ahmed El-Garci - , University of Oldenburg, Charité – Universitätsmedizin Berlin (Author)
  • Tareq A. Juratli - , Department of Neurosurgery, University Hospital Carl Gustav Carus Dresden (Author)
  • Philip Dao Trong - , Heidelberg University  (Author)
  • Martin N. Stienen - , Cantonal Hospital St. Gallen (Author)
  • Isabel Charlotte Hostettler - , Cantonal Hospital St. Gallen, Technical University of Munich (Author)
  • Morgan Broggi - , IRCCS Fondazione Istituto Neurologico Carlo Besta - Milano (Author)
  • Johannes Sarnthein - , University of Zurich (Author)
  • Luca Regli - , University of Zurich (Author)
  • Oliver Bozinov - , Cantonal Hospital St. Gallen (Author)
  • Marian Christoph Neidert - , Cantonal Hospital St. Gallen (Author)

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.

Details

Original languageEnglish
Pages (from-to)37600
Number of pages1
JournalScientific reports
Volume15
Issue number1
Publication statusPublished - 28 Oct 2025
Peer-reviewedYes

External IDs

PubMedCentral PMC12569239
Scopus 105020352587

Keywords

Keywords

  • Classification, Complication, Complications, Cranial, Outcome, Spinal