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(Chest. 2000;118:566.)
© 2000 American College of Chest Physicians

Radiographic Criteria in ARDS

Gloria E. Westney, MD

Morehouse School of Medicine Atlanta, GA

Correspondence to: Gloria E. Westney, MD, Associate Professor of Medicine, Morehouse School of Medicine, 720 Westview Dr, SW, Atlanta, GA 30310

To the Editor:

The article by Rubenfeld et al in a recent issue of CHEST (November 1999)1 highlighted a key problem when applying clinical parameters to the definition of a syndrome.

In the daily care of an ARDS patient, physicians of various specialties and other health-care personnel are often the first individuals reviewing the chest x-ray (CXR). However, it is the interpretation from the radiology department that is officially used in the patient records.

One useful modification to the CXR criteria may be to specify that the official radiographic interpretation by a radiologist be used in the definition of ARDS. Perhaps we also need to develop and validate more explicit and concrete CXR criteria within the discipline of radiology so as to eliminate interobserver variability.2

Developing explicit and reproducible diagnostic criteria is the only way we can apply the American-European Consensus Conference definition to research protocols among multiple study centers.

References

  1. Rubenfeld, GD, Caldwell, E, Granton, J, et al (1999) Interobserver variability in applying a radiographic definition for ARDS. Chest 116,1347-1353[Abstract/Free Full Text]
  2. Melbye, H, Dale, K (1992) Interobserver variability in the radiographic diagnosis of adult outpatient pneumonia. Acta Radiol 33,79-81[ISI][Medline]

Gordon D. Rubenfeld, MD, MSc

Harborview Medical Center Seattle, WA

Correspondence to: Gordon D. Rubenfeld, MD, MSc, Department of Pulmonary and Critical Care Medicine, Harborview Medical Center, 325 Ninth Ave, Seattle, WA; e-mail: nodrog{at}u.washington.edu

To the Editor:

We agree with the comments by Dr. Westney. As discussed in our article, we believe that the solution to the interobserver variability problem in the radiographic definition of ARDS is more explicit definitions that have been subjected to empiric validation. It is particularly important that any subsequent attempt to operationalize this definition be accompanied by example radiographs.

As data become available showing improved outcome from various interventions in patients with acute lung injury and ARDS, it will be essential for clinicians at the bedside to be able to identify the same patients in the same time frame as those who benefited from the clinical trial.

References

  1. Rubenfeld, GD, Caldwell, E, Granton, J, et al (1999) Interobserver variability in applying a radiographic definition for ARDS. Chest 116,1347-1353
  2. Melbye, H, Dale, K (1992) Interobserver variability in the radiographic diagnosis of adult outpatient pneumonia. Acta Radiol 33,79-81




This Article
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Right arrow Articles by Westney, G. E.
Right arrow Articles by Rubenfeld, G. D.

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