Diagnostic Performance of the Radiographic Assessment of Lung Edema Score for Acute Respiratory Distress Syndrome—Post Hoc Analysis of the “Validating Acute Lung Injury Biomarkers for Diagnosis” Study
Claudio Zimatore, Matthieu Jabaudon, Luigi Pisani, Tatsuki Koyama, Marcus J. Schultz, Lorraine B. WareOBJECTIVES:
To determine the diagnostic accuracy of the Radiographic Assessment of Lung Edema (RALE) score for acute respiratory distress syndrome (ARDS) and its interobserver reliability.
DESIGN:
Post hoc analysis of a prospective observational cohort study.
SETTING:
ICUs at Vanderbilt University Medical Center participating in the Validating Acute Lung Injury Biomarkers for Diagnosis study.
PATIENTS:
Adult patients receiving invasive ventilation for at least two consecutive days, with chest radiographs available on the first 2 ICU days.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
Chest radiographs from the first 2 ICU days were scored independently by at least two experienced raters; scores were averaged per radiograph, and the highest averaged score from ICU day 1 or 2 was selected for analysis. The primary outcome was ARDS according to the Berlin definition during the first 2 ICU days. Of 236 patients, 92 (39%) had ARDS. The median RALE score was higher in patients with ARDS than in those without (29.5 [22.2–34.5] vs. 12.2 [7.5–17.8];
CONCLUSIONS:
In patients invasively ventilated for at least 2 days, the RALE score demonstrated excellent diagnostic accuracy for ARDS at a cutoff of 20, together with high interobserver reliability, supporting its potential role as a standardized radiographic tool in the diagnosis of ARDS.