Agate respiratory distress syndrome:: Underrecognition by clinicians and diagnostic accuracy of three clinical definitions
Agate respiratory distress syndrome:: Underrecognition by clinicians and diagnostic accuracy of three clinical definitions
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DOI：
10.1097/01.ccm.0000181529.08630.49
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发表时间：
2005-10-01
影响因子：
8.8
通讯作者：
Stewart, TE
中科院分区：
文献类型：
--
作者：
Ferguson, ND;Frutos-Vivar, F;Stewart, TE
目的：确定并比较三种急性呼吸窘迫综合征（ARDS）临床定义的诊断准确性：(1)美欧共识会议定义；(2)肺损伤评分；(3)最近开发的德尔菲定义。第二个目的是确定日常实践中ARDS临床诊断的准确性。设计：将尸检结果与临床定义的日常状态进行独立比较，并从医疗记录中回顾性提取数据。环境：三级重症监护室。病人：从1995年到2001年，138名在机械通气后死亡的病人。干预措施：临床ARDS诊断是在不知道尸检结果的情况下每天确定的。在临床记录中查看图表是否提及ARDS。尸检由两名病理学家独立审查弥漫性肺泡损伤的存在。以尸检时弥漫性肺泡损伤作为参考标准确定定义的敏感性和特异性。测量和主要结果：138例尸检中有42例（30.4%）出现弥漫性肺泡损伤。42例患者中仅有20例（47.6%）在病历中提及ARDS。敏感性和特异性（95%置信区间）如下：美国-欧洲定义，0.83 (0.72-0.95),0.51 (0.41-0.61)；肺损伤评分分别为0.74（0.61 ~ 0.87）、0.77 (0.69 ~ 0.86)；德尔菲定义为0.69(0.55 ~ 0.83),0.82（0.75 ~ 0.90）。肺损伤评分和德尔菲定义的特异性明显高于美欧定义(p
Objective: To determine and compare the diagnostic accuracy of three clinical definitions of acute respiratory distress syndrome (ARDS): (1) the American-European consensus conference definition; (2) the lung injury score; and (3) a recently developed Delphi definition. A second objective was to determine the accuracy of clinical diagnoses of ARDS made in daily practice.Design: Independent comparison of autopsy findings with the daily status of clinical definitions, constructed with data abstracted retrospectively from medical records.Setting: Tertiary intensive care unit.Patients: One hundred thirty-eight patients from the period 1995 through 2001 who were autopsied after being mechanically ventilated.Interventions: Clinical ARDS diagnoses were determined daily without knowledge of autopsy results. Charts were reviewed for any mention of ARDS in the clinical notes. Autopsies were reviewed independently by two pathologists for the presence of diffuse alveolar damage. The sensitivity and specificity of the definitions were determined with use of diffuse alveolar damage at autopsy as the reference standard.Measurements and Main Results: Diffuse alveolar damage at autopsy was documented in 42 of 138 cases (30.4%). Only 20 of these 42 patients (47.6%) had any mention of ARDS in their chart. Sensitivities and specificities (95% confidence intervals) were as follows: American-European definition, 0.83 (0.72-0.95), 0.51 (0.41-0.61); lung injury score, 0.74 (0.61-0.87), 0.77 (0.69-0.86); and Delphi definition, 0.69 (0.55-0.83), 0.82 (0.75-0.90). Specificity was significantly higher for both the lung injury score and Delphi definition than for the American-European definition (p