Articles
21 September 2004

Comparison of Clinical Criteria for the Acute Respiratory Distress Syndrome with Autopsy Findings

Publication: Annals of Internal Medicine
Volume 141, Number 6

Abstract

Background:

The American–European Consensus Conference definition for the acute respiratory distress syndrome (ARDS) has never been validated.

Objective:

To compare clinical criteria for ARDS with autopsy findings.

Design:

Independent comparison of autopsy findings with clinical characteristics retrospectively abstracted from medical records.

Setting:

Tertiary medical–surgical intensive care unit.

Participants:

382 patients who underwent clinical autopsy.

Measurements:

Sensitivity, specificity, and likelihood ratios for clinical criteria were calculated in 3 cohorts by using diffuse alveolar damage at autopsy as the reference standard. The 3 cohorts were 1) all patients, 2) patients with any risk factor for ARDS, and 3) patients who were separated according to their pulmonary or extrapulmonary risk factors.

Results:

127 patients (33%) met the clinical criteria, and 112 (29%) had diffuse alveolar damage. In all patients, the sensitivity of the clinical definition was 75% (95% CI, 66% to 82%) and the specificity was 84% (CI, 79% to 88%). In 284 patients with risk factors, the sensitivity was 76% (CI, 67% to 83%) and the specificity was 75% (CI, 68% to 81%). Compared with patients with pulmonary risk factors, patients with extrapulmonary risk factors had significantly higher sensitivity (61% vs. 85%; P = 0.009) and the specificity did not statistically significantly differ (69% vs. 78%; P > 0.2).

Limitations:

Only patients who died and underwent autopsy could be included in this study, so these results may not apply to less severe cases of ARDS.

Conclusions:

In a series of autopsy patients, the accuracy of the American–European Consensus Conference definition of ARDS was only moderate. The definition was more accurate for patients with extrapulmonary risk factors than for patients with pulmonary risk factors.

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References

1.
Ashbaugh DGBigelow DBPetty TLLevine BE. Acute respiratory distress in adults. Lancet. 1967;2:319-23. [PMID: 4143721]
2.
Garber BGHébert PCYelle JDHodder RVMcGowan J. Adult respiratory distress syndrome: a systemic overview of incidence and risk factors. Crit Care Med. 1996;24:687-95. [PMID: 8612424]
3.
Bernard GRArtigas ABrigham KLCarlet JFalke KHudson Let al . The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818-24. [PMID: 7509706]
4.
Katzenstein ALBloor CMLeibow AA. Diffuse alveolar damage—the role of oxygen, shock, and related factors. A review. Am J Pathol. 1976;85:209-28. [PMID: 788524]
5.
Goodman LRFumagalli RTagliabue PTagliabue MFerrario MGattinoni Let al . Adult respiratory distress syndrome due to pulmonary and extrapulmonary causes: CT, clinical, and functional correlations. Radiology. 1999;213:545-52. [PMID: 10551239]
6.
Gattinoni LPelosi PSuter PMPedoto AVercesi PLissoni A. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med. 1998;158:3-11. [PMID: 9655699]
7.
Lim CMKim EKLee JSShim TSLee SDKoh Yet al . Comparison of the response to the prone position between pulmonary and extrapulmonary acute respiratory distress syndrome. Intensive Care Med. 2001;27:477-85. [PMID: 11355115]
8.
Fernandez-Segoviano PLázaro AEsteban ARubio JMIruretagoyena JR. Autopsy as quality assurance in the intensive care unit. Crit Care Med. 1988;16:683-5. [PMID: 3371045]
9.
Tomashefski JF Jr. Pulmonary pathology of acute respiratory distress syndrome. Clin Chest Med. 2000;21:435-66. [PMID: 11019719]
10.
Jaeschke RGuyatt GSackett DL. Users' guides to the medical literature. III. How to use an article about a diagnostic test. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 1994;271:389-91. [PMID: 8283589]
11.
Agresti A. Analysis of Ordinal Categorical Data. New York: John Wiley; 1984.
12.
Deeks JJ. Systematic reviews of evaluations of diagnostic and screening tests. In: Egger M, Smith GD, Altman DG, eds. Systematic Reviews in Health Care. Meta-Analysis in Context. London: BMJ Books; 2001:248-82.
13.
Zamora J, Muriel A, Abraira V. Meta-DiSc for Windows: A Software Package for the Meta-Analysis of Diagnostic Tests. Presented at XI Cochrane Colloquium, Barcelona, Spain, 25 October–1 November 2003. Accessed at www.hrc.es/investigacion/metadisc.html on 16 April 2004.
14.
Ferguson NDFrutos-Vivar FEsteban A. Mortality rates in patients with ARDS: what should be the reference standard. In: Vincent JL, eds. Yearbook of Intensive Care and Emergency Medicine. Berlin: Springer; 2003:231-42.
15.
Estenssoro EDubin ALaffaire ECanales HSáenz GMoseinco Met al . Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome. Crit Care Med. 2002;30:2450-6. [PMID: 12441753]
16.
Hudson LDSteinberg KP. Epidemiology of acute lung injury and ARDS. Chest. 1999;116:74S-82S. [PMID: 10424602]
17.
Lewandowski KMetz JDeutschmann CPreiss HKuhlen RArtigas Aet al . Incidence, severity, and mortality of acute respiratory failure in Berlin, Germany. Am J Respir Crit Care Med. 1995;151:1121-5. [PMID: 7697241]
18.
Thomsen GEMorris AH. Incidence of the adult respiratory distress syndrome in the state of Utah. Am J Respir Crit Care Med. 1995;152:965-71. [PMID: 7663811]
19.
Roupie ELepage EWysocki MFagon JYChastre JDreyfuss Det al . Prevalence, etiologies and outcome of the acute respiratory distress syndrome among hypoxemic ventilated patients. SRLF Collaborative Group on Mechanical Ventilation. Société de Réanimation de Langue Française. Intensive Care Med. 1999;25:920-9. [PMID: 10501746]
20.
Amato MBBarbas CSMedeiros DMMagaldi RBSchettino GPLorenzi-Filho Get al . Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998;338:347-54. [PMID: 9449727]
21.
Brochard LRoudot-Thoraval FRoupie EDelclaux CChastre JFernandez-Mondéjar Eet al . Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The Multicenter Trail Group on Tidal Volume reduction in ARDS. Am J Respir Crit Care Med. 1998;158:1831-8. [PMID: 9847275]
22.
Stewart TEMeade MOCook DJGranton JTHodder RVLapinsky SEet al . Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. Pressure- and Volume-Limited Ventilation Strategy Group. N Engl J Med. 1998;338:355-61. [PMID: 9449728]
23.
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342:1301-8. [PMID: 10793162]
24.
Meduri GUHeadley ASGolden ECarson SJUmberger RAKelso Tet al . Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized, controlled trial. JAMA. 1998;280:159-65. [PMID: 9669790]
25.
Anzueto ABaughman RPGuntupalli KKWeg JGWiedemann HPRaventós AAet al . Aerosolized surfactant in adults with sepsis-induced acute respiratory distress syndrome. Exosurf Acute Respiratory Distress Syndrome Sepsis Study Group. N Engl J Med. 1996;334:1417-21. [PMID: 8618579]
26.
Esteban AAlía IGordo Fde Pablo RSuarez JGonzález Get al . Prospective randomized trial comparing pressure-controlled ventilation and volume-controlled ventilation in ARDS. For the Spanish Lung Failure Collaborative Group. Chest. 2000;117:1690-6. [PMID: 10858404]
27.
Goldman LSayson RRobbins SCohn LHBettmann MWeisberg M. The value of the autopsy in three medical eras. N Engl J Med. 1983;308:1000-5. [PMID: 6835306]
28.
Zaitoun AMFernandez C. The value of histological examination in the audit of hospital autopsies: a quantitative approach. Pathology. 1998;30:100-4. [PMID: 9643486]
29.
Esteban AFernández-Segoviano P. The autopsy as a tool to monitor diagnostic error [Editorial]. Intensive Care Med. 1999;25:343-4. [PMID: 10342503]
30.
Silfvast TTakkunen OKolho EAndersson LCRosenberg P. Characteristics of discrepancies between clinical and autopsy diagnoses in the intensive care unit: a 5-year review. Intensive Care Med. 2003;29:321-4. [PMID: 12594594]
31.
Esteban AFernández-Segoviano P. Is autopsy dead in the ICU? Intensive Care Med. 2003;29:522-5. [PMID: 12644908]
32.
Palazón CPalazón EPardo JCGil BBlanco TEspinosa JLet al . Hallazgos en los estudios necrópsicos realizados en pacientes críticos. Medicina Intensiva. 1999;23:6-9.
33.
Torres Ael-Ebiary MPadró LGonzalez Jde la Bellacasa JPRamirez Jet al . Validation of different techniques for the diagnosis of ventilator-associated pneumonia. Comparison with immediate postmortem pulmonary biopsy. Am J Respir Crit Care Med. 1994;149:324-31. [PMID: 8306025]
34.
Fàbregas NEwig STorres AEl-Ebiary MRamirez Jde La Bellacasa JPet al . Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsies. Thorax. 1999;54:867-73. [PMID: 10491448]

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Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 141Number 621 September 2004
Pages: 440 - 445

History

Published online: 21 September 2004
Published in issue: 21 September 2004

Keywords

Authors

Affiliations

Andrés Esteban, MD, PhD
From the Hospital Universitario de Getafe, Madrid, Spain, and University Health Network, University of Toronto, Toronto, Ontario, Canada.
Pilar Fernández-Segoviano, MD, PhD
From the Hospital Universitario de Getafe, Madrid, Spain, and University Health Network, University of Toronto, Toronto, Ontario, Canada.
Fernando Frutos-Vivar, MD
From the Hospital Universitario de Getafe, Madrid, Spain, and University Health Network, University of Toronto, Toronto, Ontario, Canada.
José Antonio Aramburu, MD
From the Hospital Universitario de Getafe, Madrid, Spain, and University Health Network, University of Toronto, Toronto, Ontario, Canada.
Laura Nájera, MD
From the Hospital Universitario de Getafe, Madrid, Spain, and University Health Network, University of Toronto, Toronto, Ontario, Canada.
Niall D. Ferguson, MD, MSc
From the Hospital Universitario de Getafe, Madrid, Spain, and University Health Network, University of Toronto, Toronto, Ontario, Canada.
Inmaculada Alía, MD
From the Hospital Universitario de Getafe, Madrid, Spain, and University Health Network, University of Toronto, Toronto, Ontario, Canada.
Federico Gordo, MD
From the Hospital Universitario de Getafe, Madrid, Spain, and University Health Network, University of Toronto, Toronto, Ontario, Canada.
Fernando Ríos, MD
From the Hospital Universitario de Getafe, Madrid, Spain, and University Health Network, University of Toronto, Toronto, Ontario, Canada.
Acknowledgments: The authors thank Victor Abraira from Unidad de Bioestadística of Hospital Ramón y Cajal, Madrid, Spain, for statistical advice.
Grant Support: By Red Gira G03/063 and Red Respira C03/11, Instituto de Salud Carlos III, Spain. Dr. Ferguson was supported by a Canadian Institutes of Health Research, Canadian Lung Association, postdoctoral fellowship.
Disclosures: None disclosed.
Corresponding Author: Andrés Esteban, MD, PhD, Unidad de Cuidados Intensivos Hospital Universitario de Getafe, Carretera de Toledo Km 12,500 Getafe 28905, Madrid, Spain; e-mail, [email protected].
Author Contributions: Conception and design: A. Esteban, P. Fernández-Segoviano, F. Frutos-Vivar, L. Nájera, I. Alía, F. Gordo, F. Ríos.
Analysis and interpretation of the data: A. Esteban, P. Fernández-Segoviano, F. Frutos-Vivar, J.A. Aramburu, L. Nájera, N.D. Ferguson, I. Alía, F. Gordo, F. Ríos.
Drafting of the article: A. Esteban, F. Frutos-Vivar, I. Alía.
Critical revision of the article for important intellectual content: A. Esteban, P. Fernández-Segoviano, F. Frutos-Vivar, J.A. Aramburu, L. Nájera, N.D. Ferguson.
Final approval of the article: N.D. Ferguson.
Statistical expertise: N.D. Ferguson
Current Author Addresses: Drs. Esteban, Frutos-Vivar, and Alía: Intensive Care Unit, Hospital Universitario de Getafe, Carretera de Toledo Km 12,500, Getafe 28905, Madrid, Spain.
Drs. Fernández-Segoviano, Aramburu, and Nájera: Department of Pathology, Hospital Universitario de Getafe, Carretera de Toledo Km 12,500, Getafe 28905, Madrid, Spain.
Dr. Ferguson: Respirology and Critical Care Medicine, University Health Network, Toronto Western Hospital, EC2-024, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
Dr. Gordo: Intensive Care Unit, Fundación Hospital de Alcorcón, Budapest, 1, Alcorcón 28922, Madrid, Spain.
Dr. Ríos: Hospital Profesor Posadas, Poniente Illia s/n y Marconi, El Palomar 1706, Buenos Aires, Argentina.

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Andrés Esteban, Pilar Fernández-Segoviano, Fernando Frutos-Vivar, et al. Comparison of Clinical Criteria for the Acute Respiratory Distress Syndrome with Autopsy Findings. Ann Intern Med.2004;141:440-445. [Epub 21 September 2004]. doi:10.7326/0003-4819-141-6-200409210-00009

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