title: Decision support tool for differential diagnosis of Acute Respiratory Distress Syndrome (ARDS) vs Cardiogenic Pulmonary Edema (CPE): a prospective validation and meta-analysis.
abstract: BACKGROUND
  We recently presented a prediction score providing decision support with the often-challenging early differential diagnosis of acute lung injury (ALI) vs cardiogenic pulmonary edema (CPE). To facilitate clinical adoption, our objective was to prospectively validate its performance in an independent cohort.
  
  
  METHODS
  Over 9 months, adult patients consecutively admitted to any intensive care unit of a tertiary-care center developing acute pulmonary edema were identified in real-time using validated electronic surveillance. For eligible patients, predictors were abstracted from medical records within 48 hours of the alert. Post-hoc expert review blinded to the prediction score established gold standard diagnosis.
  
  
  RESULTS
  Of 1,516 patients identified by electronic surveillance, data were abstracted for 249 patients (93% within 48 hours of disease onset), of which expert review (kappa 0.93) classified 72 as ALI, 73 as CPE and excluded 104 as "other". With an area under the curve (AUC) of 0.81 (95% confidence interval = 0.73 to 0.88) the prediction score showed similar discrimination as in prior cohorts (development AUC = 0.81, P = 0.91; retrospective validation AUC = 0.80, P = 0.92). Hosmer-Lemeshow test was significant (P = 0.01), but across eight previously defined score ranges probabilities of ALI vs CPE were the same as in the development cohort (P = 0.60). Results were the same when comparing acute respiratory distress syndrome (ARDS, Berlin definition) vs CPE.
  
  
  CONCLUSIONS
  The clinical prediction score reliably differentiates ARDS/ALI vs CPE. Pooled results provide precise estimates of the score's performance which can be used to screen patient populations or to assess the probability of ALI/ARDS vs CPE in specific patients. The score may thus facilitate early inclusion into research studies and expedite prompt treatment.
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. christopher.schmickl@mail.harvard.edu.|University Witten-Herdecke, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany. christopher.schmickl@mail.harvard.edu.|Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. christopher.schmickl@mail.harvard.edu.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Schmickl
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. sonalrmd@gmail.com.
authors.forename: Sonal
authors.initials: S
authors.lastname: Pannu
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. alqadi.mazen@mayo.edu.
authors.forename: Mazen O
authors.initials: MO
authors.lastname: Al-Qadi
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. anasalsara@gmail.com.
authors.forename: Anas
authors.initials: A
authors.lastname: Alsara
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. Kashyap.Rahul@mayo.edu.
authors.forename: Rahul
authors.initials: R
authors.lastname: Kashyap
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. rdhokarh@gmail.com.|Lahey Clinic, Pulmonary and Critical Care, 41 Burlington Mall Road, Burlington, MA, 01805, USA. rdhokarh@gmail.com.
authors.forename: Rajanigandha
authors.initials: R
authors.lastname: Dhokarh
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. Herasevich.Vitaly@mayo.edu.
authors.forename: Vitaly
authors.initials: V
authors.lastname: Herasevich
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. Gajic.Ognjen@mayo.edu.
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
mesh_terms: D055371:Acute Lung Injury / Q000175:diagnosis* / Q000453:epidemiology; D000328:Adult; D000368:Aged; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000175:diagnosis* / Q000453:epidemiology; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000175:diagnosis* / Q000453:epidemiology