Misclassification of acute respiratory distress syndrome after traumatic injury: The cost of less rigorous approaches.
Misclassification of acute respiratory distress syndrome after traumatic injury: The cost of less rigorous approaches.
复制标题
创伤性损伤后急性呼吸窘迫综合征的错误分类：严格方法的成本。
DOI：
10.1097/ta.0000000000000760
复制
发表时间：
2015-09
期刊：
影响因子：
--
通讯作者：
Cohen MJ
中科院分区：
文献类型：
--
作者：
Hendrickson CM;Dobbins S;Redick BJ;Greenberg MD;Calfee CS;Cohen MJ
Adherence to rigorous research protocols for identifying acute respiratory distress syndrome (ARDS) after trauma is variable. To examine how misclassification of ARDS may bias observational studies in trauma populations, we evaluated the agreement of two methods for adjudicating ARDS after trauma: the gold standard, direct review of chest radiographs and review of dictated radiology reports, a commonly used alternative. This nested cohort study included 123 mechanically ventilated patients between 2005–2008, with at least one PaO2:FiO2 <300 within the first 8 days of admission. Two blinded physician investigators adjudicated ARDS by two methods. The investigators directly reviewed all chest radiographs to evaluate for bilateral infiltrates. Several months later, blinded to their previous assessments, they adjudicated ARDS using a standardized rubric to classify radiology reports. A kappa statistics was calculated. Regression analyses quantified the association between established risk factors as well as important clinical outcomes and ARDS determined by the aforementioned methods as well as hypoxemia as a surrogate marker. The kappa was 0.47 for the observed agreement between ARDS adjudicated by direct review of chest radiographs and ARDS adjudicated by review of radiology reports. Both the magnitude and direction of bias on the estimates of association between ARDS and established risk factors as well as clinical outcomes varied by method of adjudication. Classification of ARDS by review of dictated radiology reports had only moderate agreement with the gold standard, ARDS adjudicated by direct review of chest radiographs. While the misclassification of ARDS had varied effects on the estimates of associations with established risk factors, it tended to weaken the association of ARDS with important clinical outcomes. A standardized approach to ARDS adjudication after trauma by direct review of chest radiographs will minimize misclassification bias in future observational studies. Level III; Epidemiologic
