title: Accuracy of clinical diagnosis of acute respiratory distress syndrome in comparison with autopsy findings.
abstract: OBJECTIVE
  To compare the American-European Consensus Conference (AECC) definition of acute respiratory distress syndrome (ARDS) to autopsy findings.
  
  
  METHODS
  All patients who died in the intensive care unit of the Federal University of Juiz de Fora University Hospital between 1995 and 2003 and were submitted to autopsy were included in the study. Patient clinical charts were reviewed to establish whether cases met the AECC criteria for a diagnosis of ARDS, histologically defined as the presence of diffuse alveolar damage (DAD).
  
  
  RESULTS
  During the study period, 592 patients died, and 22 were submitted to autopsy. Of those 22 patients, 10 (45%) met the AECC criteria, and 7 (32%) met the histopathological criteria for DAD. The AECC clinical criteria presented a sensitivity of 71% (95%CI: 36-92%) and a specificity of 67% (95%CI: 42-85%). The positive and negative predictive values were, respectively, 50 and 83%, whereas the positive and negative likelihood ratios were, respectively, 2.33 and 0.47. The histopathological findings in the 5 patients who met AECC criteria but did not present DAD were pneumonia (n = 2), pulmonary embolism (n = 1), tuberculosis (n = 1), and cryptococcosis (n = 1).
  
  
  CONCLUSIONS
  The accuracy of the AECC definition of ARDS was godless than satisfactory. Due to the low positive predictive value and the low positive likelihood ratio, other hypotheses must be considered when ARDS is suspected.
authors.affiliation: Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil. bruno.pinheiro@otimize.med.br
authors.forename: Bruno Valle
authors.initials: BV
authors.lastname: Pinheiro
authors.forename: Fabiana Sayuri
authors.initials: FS
authors.lastname: Muraoka
authors.forename: Raimunda Violante Campos
authors.initials: RV
authors.lastname: Assis
authors.forename: Raul
authors.initials: R
authors.lastname: Lamin
authors.forename: Sérgio Paulo dos Santos
authors.initials: SP
authors.lastname: Pinto
authors.forename: Paulo Justiniano
authors.initials: PJ
authors.lastname: Ribeiro
authors.forename: Júlio César Abreu de
authors.initials: JC
authors.lastname: Oliveira
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001344:Autopsy; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007362:Intensive Care Units; D007391:International Cooperation; D016013:Likelihood Functions; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011237:Predictive Value of Tests; D011650:Pulmonary Alveoli / Q000473:pathology; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies