title: Development of a clinical definition for acute respiratory distress syndrome using the Delphi technique.
abstract: OBJECTIVE
  The objective of this study is to describe the implementation of formal consensus techniques in the development of a clinical definition for acute respiratory distress syndrome.
  
  
  METHODS
  A Delphi consensus process was conducted using e-mail. Sixteen panelists who were both researchers and opinion leaders were systematically recruited. The Delphi technique was performed over 4 rounds on the background of an explicit definition framework. Item generation was performed in round 1, item reduction in rounds 2 and 3, and definition evaluation in round 4. Explicit consensus thresholds were used throughout.
  
  
  RESULTS
  Of the 16 panelists, 11 actually participated in developing a definition that met a priori consensus rules on the third iteration. New incorporations in the Delphi definition include the use of a standardized oxygenation assessment and the documentation of either a predisposing factor or decreased thoracic compliance. The panelists rated the Delphi definition as acceptable to highly acceptable (median score, 6; range, 5-7 on a 7-point Likert scale).
  
  
  CONCLUSIONS
  We conclude that it is feasible to consider using formal consensus in the development of future definitions of acute respiratory distress syndrome. Testing of sensibility, reliability, and validity are needed for this preliminary definition; these test results should be incorporated into future iterations of this definition.
authors.affiliation: Interdepartmental Division of Critical Care, University of Toronto, ON, Canada. n.ferguson@utoronto.ca
authors.forename: Niall D
authors.initials: ND
authors.lastname: Ferguson
authors.forename: Aileen M
authors.initials: AM
authors.lastname: Davis
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Slutsky
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Stewart
mesh_terms: D003697:Delphi Technique; D034742:Electronic Mail; D005260:Female; D006801:Humans; D008297:Male; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000503:physiopathology