Related Experiment Videos
Interobserver variability in applying a radiographic definition for ARDS
G D Rubenfeld1, E Caldwell, J Granton
1Harborview Medical Center and the Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle WA 98104, USA. nodrog@u.washington.edu
Chest
|November 13, 1999
Summary
The radiographic criterion for Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) shows significant interobserver variability. This inconsistency may impact clinical research and patient care, suggesting a need for definition refinement.
Area of Science:
- Pulmonary Medicine
- Radiology
- Critical Care Medicine
Background:
- Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) are critical conditions often diagnosed using the American-European Consensus Conference (AECC) definition.
- This definition includes a radiographic criterion, but its reliability and accuracy have not been thoroughly evaluated by expert consensus.
- There is a lack of assessment on the interobserver variability of the AECC radiographic criterion for ALI-ARDS.
Purpose of the Study:
- To investigate the interobserver variability in the application of the American-European Consensus Conference (AECC) radiographic criterion for diagnosing ALI-ARDS.
- To assess the consistency among experts when interpreting chest radiographs for ALI-ARDS according to the AECC definition.
Main Methods:
- A survey-based study involving 21 experts in mechanical ventilation and ARDS.
- Participants reviewed 28 randomly selected chest radiographs of hypoxemic patients (PaO2/FiO2 ratio < 300).
- Experts determined if each radiograph met the AECC definition for ALI-ARDS.
Main Results:
- Moderate interobserver agreement was observed (kappa = 0.55) in applying the AECC radiographic criterion for ALI-ARDS.
- A significant portion of radiographs (43%) had near-complete agreement, while 32% had substantial disagreement among readers.
- Reader interpretation of ALI-ARDS consistency varied widely (36% to 71%), with challenges noted in identifying mild infiltrates, effusions, and atelectasis.
Conclusions:
- The radiographic criterion in the current AECC definition for ALI-ARDS exhibits high interobserver variability among specialists.
- This variability can lead to inconsistencies in defining ALI-ARDS patient populations across research centers and complicate the clinical application of research findings.
- Modifications to the radiographic criterion or the use of reference radiographs are suggested to enhance the reliability of future ALI-ARDS definitions.