title: Comparison of clinical criteria for the acute respiratory distress syndrome with autopsy findings.
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.
  
  
  METHODS
  Independent comparison of autopsy findings with clinical characteristics retrospectively abstracted from medical records.
  
  
  METHODS
  Tertiary medical-surgical intensive care unit.
  
  
  METHODS
  382 patients who underwent clinical autopsy.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Hospital Universitario de Getafe, Madrid, Spain. aesteban@ucigetafe.com
authors.forename: Andrés
authors.initials: A
authors.lastname: Esteban
authors.forename: Pilar
authors.initials: P
authors.lastname: Fernández-Segoviano
authors.forename: Fernando
authors.initials: F
authors.lastname: Frutos-Vivar
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Aramburu
authors.forename: Laura
authors.initials: L
authors.lastname: Nájera
authors.forename: Niall D
authors.initials: ND
authors.lastname: Ferguson
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Alía
authors.forename: Federico
authors.initials: F
authors.lastname: Gordo
authors.forename: Fernando
authors.initials: F
authors.lastname: Ríos
mesh_terms: D000368:Aged; D001344:Autopsy; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D011650:Pulmonary Alveoli / Q000473:pathology*; D012015:Reference Standards; D012128:Respiratory Distress Syndrome / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity