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Published on: April 7, 2021
Clinical Outcome Discrimination in Pediatric ARDS by Chest Radiograph Severity Scoring
Yu-Chun Yan1, Wen-Han Hao1, Feng-Sen Bai1
1Department of Radiology, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China.
Insights
The radiographic assessment of lung edema (RALE) score effectively predicts prognosis in pediatric acute respiratory distress syndrome (PARDS). A RALE score above 21 on day 3 indicates better survival outcomes in PARDS patients.
Area of Science:
- Pediatric critical care medicine
- Radiology
- Respiratory medicine
Background:
- Pediatric acute respiratory distress syndrome (PARDS) lacks accurate radiological severity assessment.
- The adult radiographic assessment of lung edema (RALE) score was validated for use in PARDS.
Purpose of the Study:
- To evaluate the chest radiograph (CXR) RALE scoring method for assessing PARDS severity and prognosis.
- To determine the RALE score's effectiveness in predicting outcomes for pediatric patients.
Main Methods:
- PARDS diagnosis followed Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria.
- Two observers independently calculated RALE scores based on consolidation and density in CXR quadrants.
- Receiver Operating Characteristic (ROC) curves and survival analyses identified optimal cutoff scores for prognosis discrimination.
Main Results:
- 116 PARDS patients (median age 25 months) with 37.9% mortality were analyzed.
- Excellent inter-observer agreement (ICC=0.98) was achieved for RALE scoring.
- A Day 3 RALE score > 21 was associated with better survival (AUC=0.773, HR=9.268), with sensitivity 71.7% and specificity 76.5%.
Conclusions:
- The CXR RALE score is a reliable tool for discriminating prognosis in PARDS.
- The RALE score demonstrates strong agreement between radiologists and pediatricians.
- Pulmonary complications and a Day 3 RALE score > 21 enhance predictive effectiveness for PARDS outcomes.
Background:
There is no accurate radiological measurement to estimate the severity of pediatrics acute respiratory distress syndrome (PARDS). We validated the effectiveness of an adult radiographic assessment of lung edema (RALE) score in PARDS.
Aim:
To assess the severity and prognosis of PARDS based on a chest radiograph (CXR) RALE scoring method.
Methods:
Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria were used to diagnose PARDS. General demographics, pulmonary complications, and 28-day mortality of the patients were recorded. Subgroups were compared by prognosis (survive and death) and etiology (infection and noninfection). Two observers calculated RALE independently. Each quadrant of CXR was scored by consolidation scores 0 (none alveolar opacity), 1 (extent <25%), 2 (extent 25%-50%), 3 (50%-75%), and 4 (>75%) and density scores 1 (hazy), 2 (moderate), and 3 (dense). Quadrant score equals consolidation score times density score. Total score equals to the sum of four quadrants scores. The ROC curve and survival curve were established, and the optimal cutoff score for discrimination prognosis was set.
Results:
116 PARDS (72 boys and 44 girls) and 463 CXRs were enrolled. The median age was 25 months (5 months, 60.8 months) and with a mortality of 37.9% (44/116). The agreement between two independent observers was excellent (ICC = 0.98, 95% CI: 0.97-0.99). Day 3 score was independently associated with better survival (p < 0.001). The area under the curve of ROC was 0.773 (95% CI: 0.709-0.838). The cutoff score was 21 (sensitivity 71.7%, specificity 76.5%), and the hazard ratio (HR) was 9.268 (95% CI: 1.257-68.320). The pulmonary complication showed an HR of 3.678 (95% CI: 1.174-11.521) for the discrimination.
Conclusion:
CXR RALE score can be used in PARDS for discriminating the prognosis and has a better agreement among radiologist and pediatrician. PARDS with pulmonary complications, day 3 score whether greater than 21 points, have a better predictive effectiveness.
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