• Marry R Smit, Laura A Hagens, Nanon F L Heijnen, Luigi Pisani, CherpanathThomas G VTGVDepartment of Intensive Care, Amsterdam University Medical Center (UMC), location University of Amsterdam, Amsterdam, the Netherlands., Dave A Dongelmans, de GroothHarm-Jan SHS0000-0002-7499-076XIntensive Care, Amsterdam UMC, locatie Vrije Universiteit Amsterdam, Amsterdam, Nederland., Charalampos Pierrakos, Pieter Roel Tuinman, Claudio Zimatore, Frederique Paulus, Ronny M Schnabel, Marcus J Schultz, BergmansDennis C J JDCJJDepartment of Intensive Care, Maastricht UMC+, Maastricht, the Netherlands.School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands., BosLieuwe D JLDJDepartment of Intensive Care, Amsterdam University Medical Center (UMC), location University of Amsterdam, Amsterdam, the Netherlands., and DARTS Consortium members.
• Department of Intensive Care, Amsterdam University Medical Center (UMC), location University of Amsterdam, Amsterdam, the Netherlands.
• Am. J. Respir. Crit. Care Med. 2023 Jun 15; 207 (12): 159116011591-1601.

AbstractRationale: Lung ultrasound (LUS) is a promising tool for diagnosis of acute respiratory distress syndrome (ARDS), but adequately sized studies with external validation are lacking. Objectives: To develop and validate a data-driven LUS score for diagnosis of ARDS and compare its performance with that of chest radiography (CXR). Methods: This multicenter prospective observational study included invasively ventilated ICU patients who were divided into a derivation cohort and a validation cohort. Three raters scored ARDS according to the Berlin criteria, resulting in a classification of "certain no ARDS," or "certain ARDS" when experts agreed or "uncertain ARDS" when evaluations conflicted. Uncertain cases were classified in a consensus meeting. Results of a 12-region LUS exam were used in a logistic regression model to develop the LUS-ARDS score. Measurements and Main Results: Three hundred twenty-four (16% certain ARDS) and 129 (34% certain ARDS) patients were included in the derivation cohort and the validation cohort, respectively. With an ARDS diagnosis by the expert panel as the reference test, the LUS-ARDS score, including the left and right LUS aeration scores and anterolateral pleural line abnormalities, had an area under the receiver operating characteristic (ROC) curve of 0.90 (95% confidence interval [CI], 0.85-0.95) in certain patients of the derivation cohort and 0.80 (95% CI, 0.72-0.87) in all patients of the validation cohort. Within patients who had imaging-gold standard chest computed tomography available, diagnostic accuracy of eight independent CXR readers followed the ROC curve of the LUS-ARDS score. Conclusions: The LUS-ARDS score can be used to accurately diagnose ARDS also after external validation. The LUS-ARDS score may be a useful adjunct to a diagnosis of ARDS after further validation, as it showed performance comparable with that of the current practice with experienced CXR readers but more objectifiable diagnostic accuracy at each cutoff.

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