Comparison of Clinical Criteria for the Acute Respiratory Distress Syndrome with Autopsy Findings

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Abstract
The American–European Consensus Conference definition for the acute respiratory distress syndrome (ARDS) has never been validated. To compare clinical criteria for ARDS with autopsy findings. Independent comparison of autopsy findings with clinical characteristics retrospectively abstracted from medical records. Tertiary medical–surgical intensive care unit. 382 patients who underwent clinical autopsy. Sensitivity, specificity, and likelihood ratios for clinical criteria were calculated in 3 cohorts by using diffuse alveolar damage at autopsy as the reference standard. The 3 cohorts were 1) all patients, 2) patients with any risk factor for ARDS, and 3) patients who were separated according to their pulmonary or extrapulmonary risk factors. 127 patients (33%) met the clinical criteria, and 112 (29%) had diffuse alveolar damage. In all patients, the sensitivity of the clinical definition was 75% (95% CI, 66% to 82%) and the specificity was 84% (CI, 79% to 88%). In 284 patients with risk factors, the sensitivity was 76% (CI, 67% to 83%) and the specificity was 75% (CI, 68% to 81%). Compared with patients with pulmonary risk factors, patients with extrapulmonary risk factors had significantly higher sensitivity (61% vs. 85%; P = 0.009) and the specificity did not statistically significantly differ (69% vs. 78%; P > 0.2). Only patients who died and underwent autopsy could be included in this study, so these results may not apply to less severe cases of ARDS. In a series of autopsy patients, the accuracy of the American–European Consensus Conference definition of ARDS was only moderate. The definition was more accurate for patients with extrapulmonary risk factors than for patients with pulmonary risk factors.