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Evaluation of clinical criteria for the acute respiratory distress syndrome in pediatric patients*

Rodriguez Martinez, Carlos E. MD, MSc; Guzman, Maria C. MD; Castillo, Juan M. MD; Sossa, Monica P. MD; Ojeda, Paulina MD

Pediatric Critical Care Medicine: July 2006 - Volume 7 - Issue 4 - p 335-339
doi: 10.1097/01.PCC.0000224993.03233.63
Feature Article—Continuing Medical Education
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Objective: The primary goal of this study was to evaluate the validity of the North American-European Consensus Committee (NAECC) definition for acute respiratory distress syndrome (ARDS) in pediatric patients. A secondary aim was to evaluate the threshold value for the Pao2/Fio2 ratio, used to determine which pediatric patients have ARDS.

Design: Retrospective cohort study.

Setting: Pediatric intensive care unit.

Patients: Pediatric intensive care unit patients who required mechanical ventilation, died, and underwent autopsy between January 1, 1996, and December 31, 2002 (n = 34).

Interventions: None.

Measurements and Main Results: Clinical and chest radiograph information was collected retrospectively through chart review using a standardized data collection tool. Data included the criteria specified in the NAECC definition of ARDS and demographic information. We calculated the sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio of clinical diagnosis of ARDS compared with a pathologic diagnosis. The threshold value of Pao2/Fio2 was identified by plotting receiver operating characteristics curves and comparing the areas under the curves. The NAECC definition yielded a sensitivity of 80.7% (95% confidence interval 60–92%), specificity of 71.4% (95% confidence interval30–95), positive predictive value of 91.3% (95% confidence interval 70–98), negative predictive value of 50.0% (95% confidence interval 20–78), and likelihood ratio of 2.82. A Pao2/Fio2 <150 had a slightly higher (but not significantly different) specificity for ARDS than a value >200 (71% vs. 86%, p = .15) without changing sensitivity.

Conclusions: Our study suggests the need for further research with larger number of children to identify an optimal Pao2/Fio2threshold for identifying ARDS in this population.

Pediatric Respiratory Physician, Associate Professor, Department of Pulmonary and Pediatric Critical Care Medicine, Hospital Santa Clara, Clinica Colsanitas, Clinica Infantil Colsubsidio, Bogota, Colombia (CERM); Pediatrician, Chief, Pediatric Intensive Care Unit, Hospital Santa Clara, Bogota, Colombia (MCG); Pediatric Respiratory Physician, Associate Professor, Department of Pulmonary Medicine, Centro Esfudios Superiores (CES) Medellin, Fundacion Valle de Lilly, Cali, Colombia (JMC); Medical Epidemiologist, Chief, Department of Epidemiology, Hospital Santa Clara, Bogota, Colombia (MPS); Pathologist, Chief, Department of Pathology, Consultant Lung Pathologist, Hospital Santa Clara, Bogota, Colombia (PO).

*See also p. 393.

Address requests for reprints to: Maria C. Guzman, MD, Hospital Santa Clara, Carrera 15 No. 1-59 sur, Bogota, Colombia. E-mail: mcguzmandi@yahoo.com.mx.

©2006The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies