Archive for the 'ARDS' Category

26 Sep

Interobserver Variability in Applying a Radiographic Definition for ARDS: Conclusion

To reduce interobserver variability, future panels charged with revising the definition for ALI-ARDS should consider the issues raised by this study. An annotated set of training radiographs clarifying the interpretation of the difficult radiographic patterns identified by our readers might be a useful adjunct to a written definition. The effect of analog vs digital technique […]

25 Sep

Interobserver Variability in Applying a Radiographic Definition for ARDS: K-statistic

Because any diagnostic test may perform poorly in a specific spectrum of cases, it is possible that the poor agreement in this study reflects the sample of radiographs. We tried to simulate the broad range of chest radiographs that would be encountered in screening patients for ALI-ARDS for enrollment in a clinical trial by using […]

24 Sep

Interobserver Variability in Applying a Radiographic Definition for ARDS: ALI-ARDS screening

There was more agreement on the analog radiographs than on those taken with computed radiography. There are several possible explanations for this unexpected observation. All of the analog radiographs were selected from patients who were actually enrolled in a clinical trial, reflecting, therefore, only a subset of patients considered for inclusion. Thus difficult radiographs may […]

23 Sep

Interobserver Variability in Applying a Radiographic Definition for ARDS: Discussion

This wide range in the percentage of radiograph readers termed positive was not due to isolated outliers, but reflected a continuous distribution across all readers (Table 2). These data provide empiric evidence for the concerns that have been raised regarding the reproducibility of the ALI-ARDS definition for different institutions. If the variability in radiographic interpretation […]

22 Sep

Interobserver Variability in Applying a Radiographic Definition for ARDS: Chest radiographs

Positive chest radiographs that were interpreted with the greatest agreement had dense alveolar consolidation in all four lung quadrants (Fig 1). Radiographs that were interpreted with high variability had opacities that some readers interpreted as atelectasis and others interpreted as infiltrates, bilateral lower lobe infiltrates, small lung volumes, or overlying monitoring equipment that obscured the […]

21 Sep

Interobserver Variability in Applying a Radiographic Definition for ARDS: Results

The 21 participants had a median length of experience in critical care practice of 12 years (range, 3 to 28 years). Seventeen were from North America, and 4 were from Europe or South America. Twenty participants (95%) have lectured on mechanical ventilation or lung injury, 19 (90%) are currently engaged in clinical research in lung […]

20 Sep

Interobserver Variability in Applying a Radiographic Definition for ARDS: Materials and Methods

The study design was a survey of volunteers recruited from participants at the Toronto Mechanical Ventilation Workshop held November, 1997 and from the National Institutes of Health (NIH) ARDS Network. Chest radiographs were obtained from three sources. Two institutions that prospectively identify hypoxemic critically ill patients for the presence of ALI-ARDS (University of Washington, Harborview […]

19 Sep

Interobserver Variability in Applying a Radiographic Definition for ARDS

Since the original description of ARDS in 1967, the chest radiograph has been an essential part of its definition. In the initial report, the chest radiograph was described as presenting “patchy, bilateral alveolar infiltrates.” Since then, a variety of radiographic criteria have been described in the definition of acute lung injury (ALI)-ARDS, including “reduction in […]

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