Am. J. Respir. Crit. Care Med., Vol 152, No. 5, 11 1995, 1518-1526.
Prospective validation of an acute respiratory distress syndrome predictive score
JE Heffner, LK Brown, CA Barbieri, KS Harpel and J DeLeo
Department of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
We derived an Acute Respiratory Distress Syndrome Score (ARDS Score) from
previously described training set data. To validate its diagnostic accuracy
for identifying a complicated course (early death or prolonged intubation)
in acute lung injury, 50 patients were prospectively scored using an ARDS
Score decision threshold of > or = 2.5 to discriminate between an
uncomplicated (successful extubation after < or = 14 d) and complicated
course. Predictor factors incorporated in the ARDS Score were collected on
Day 4 and Day 7 of ARDS and included PaO2/PAO2 ratio, required positive
end-expiratory pressure (PEEP), and chest radiograph progression. The
diagnostic accuracy of the ARDS Score for determining a complicated course
as well as overall survival was compared with three other available
indices. Using receiver operating characteristic (ROC) analysis, the ARDS
Score and Lung Injury Score (LIS) had the greatest diagnostic accuracy for
determining a complicated course, but the Simplified Acute Physiology Score
(SAPS Score) (score > or = 14) more accurately identified survival. The
LIS components of static respiratory system compliance (Crs) and chest
radiograph description did not differ between patient groups. The
interobserver concordance of the dynamic chest radiograph interpretation
included in the ARDS Score was significant (p < 0.05). We conclude that
the previously derived ARDS Score has valid diagnostic accuracy for
identifying patients with ARDS who will follow a complicated course.
