• Andrés Esteban, Pilar Fernández-Segoviano, Fernando Frutos-Vivar, José Antonio Aramburu, Laura Nájera, Niall D Ferguson, Inmaculada Alía, Federico Gordo, and Fernando Ríos.
• Hospital Universitario de Getafe, Madrid, Spain. aesteban@ucigetafe.com
• Ann. Intern. Med. 2004 Sep 21; 141 (6): 440-5.

BackgroundThe American-European Consensus Conference definition for the acute respiratory distress syndrome (ARDS) has never been validated.ObjectiveTo compare clinical criteria for ARDS with autopsy findings.DesignIndependent comparison of autopsy findings with clinical characteristics retrospectively abstracted from medical records.SettingTertiary medical-surgical intensive care unit.Participants382 patients who underwent clinical autopsy.MeasurementsSensitivity, 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.Results127 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).LimitationsOnly patients who died and underwent autopsy could be included in this study, so these results may not apply to less severe cases of ARDS.ConclusionsIn 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.

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