Lung Ultrasound Prediction Model for Acute Respiratory Distress Syndrome: A Multicenter Prospective Observational Study

• DOI: 10.1164/rccm.202210-1882oc
• Publication Date: 2023-02-15T15:14:25Z
• Authors: Marry R. Smit; Laura A. Hagens; Nanon F. L. Heijnen; Luigi Pisani; Thomas G. V. Cher...; Dave A. Dongelmans; Harm-Jan S. de Gr...; Charalampos Pierr...; Pieter Roel Tuinman; Claudio Zimatore; Frederique Paulus; Ronny M. Schnabel; Marcus J. Schultz; Dennis C. J. J. B...; Lieuwe D. J. Bos; Lieuwe D. J. Bos; Laura A. Hagens; Marcus J. Schultz; Marry R. Smit; Fleur L. I. M. va...; Dennis C. J. J. B...; Hester A. Gietema; Suzanne C. Gerretsen; Nanon F. L. Heijnen; Ronny M. Schnabel; Inge Geven; Tamara M. E. Nijsen; Alwin R. M. Versc...
• Keywords: Respiratory Distress Syndrome; diagnosis; IMPROVE; LUS; 610; 600; CARE; Thorax; DIAGNOSIS; PULMONARY; 3. Good health; Radiography; diagnosi; 03 medical and health sciences; DEFINITION; 0302 clinical medicine; SCORE; Humans; ARDS; Lung; intensive care; Ultrasonography

Rationale: 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.