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  3. Improving Retrospective Ards Case-finding Using A Simple 72-h Physiologic Persistence Rule.
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  3. Improving Retrospective Ards Case-finding Using A Simple 72-h Physiologic Persistence Rule.

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Improving retrospective ARDS case-finding using a simple 72-h physiologic persistence rule.

Dominic C Marshall1,2, Brijesh V Patel3, Anthony C Gordon3

  • 1Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK. dominic.marshall12@imperial.ac.uk.

Intensive Care Medicine Experimental
|April 30, 2026

View abstract on PubMed

Summary
This summary is machine-generated.

A 72-hour persistence rule for hypoxemia improves acute respiratory distress syndrome (ARDS) identification in retrospective studies. However, it remains an enrichment strategy, not a definitive diagnostic label for ARDS.

Keywords:
Acute respiratory distress syndromeCase-findingIdentificationPersistencePhenotyping

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Area of Science:

  • Critical Care Medicine
  • Respiratory Medicine
  • Health Informatics

Background:

  • Retrospective studies often use single-time-point Berlin criteria (PaO2/FiO2 < 300 with PEEP ≥ 5) to identify acute respiratory distress syndrome (ARDS).
  • Transient hypoxemia is common in critically ill patients and may lead to overestimation of ARDS prevalence.
  • Current screening methods may yield cohorts inconsistent with clinical trial populations.

Purpose of the Study:

  • To determine if a 72-hour persistence criterion for hypoxemia improves ARDS case identification accuracy.
  • To evaluate the additional value of radiology keyword searches and ICD codes in ARDS case finding.
  • To assess the impact of varying hypoxemia persistence durations on ARDS prevalence.

Main Methods:

  • Retrospective cohort study using MIMIC-IV and a UK ICU dataset for derivation and validation.
  • Identified patients meeting Berlin criteria for at least 72 hours.
  • Expert adjudication of 2000 patients from MIMIC-IV based on clinical notes, imaging, and echocardiography.
  • Sensitivity analyses performed for 24-h and 48-h persistence criteria.
  • Compared diagnostic performance of radiology keywords and ICD codes against expert adjudication.

    • Main Results:

    • Of 3940 patients meeting the 72-h persistence threshold, expert adjudication confirmed ARDS in 49.7% (MIMIC-IV) and 56% (UK cohort).
    • ARDS prevalence decreased significantly with shorter persistence: 21% (48h), 8% (24h), and 6% (single measurement).
    • Radiology keywords showed limited sensitivity (49%) and moderate specificity (76%), while ICD codes had higher sensitivity (76%) but low specificity (47%) within the 72-h enriched sample.

    Conclusions:

    • Single-time-point Berlin criteria are inadequate for retrospective ARDS identification.
    • A ≥72-hour persistence rule enhances cohort enrichment but does not definitively diagnose ARDS, with residual misclassification.
    • Persistence criteria should be considered a pragmatic enrichment strategy, not a definitive retrospective ARDS label.