LUS-ARDS promising for accurate diagnosis of acute respiratory distress syndrome

"The LUS-ARDS score may be a useful adjunct to ARDS diagnosis after further validation, as its performance was comparable with the current practice with experienced CXR readers but more objectifiable diagnostic accuracy at each cutoff," the researchers wrote.

Lung ultrasound is a promising tool for diagnosing acute respiratory distress syndrome, but more adequately sized studies with external validation must be needed. Marry R. Smit, Amsterdam University Medical Center (UMC), Amsterdam, the Netherlands, and colleagues aimed to develop and validate a data-driven LUS score for ARDS diagnosis and compare its performance with chest radiography (CXR) in a multicenter prospective observational study.

The study included ICU patients who were invasively ventilated. They were divided into a derivation cohort and a validation cohort. ARDS was scored based on the Berlin criteria by three raters, resulting in a classification of "certain no ARDS," or "certain ARDS" when experts agreed or "uncertain ARDS" when evaluations conflicted. Pending cases were classified in a consensus meeting. The LUS-ARDS score was developed using the results of a 12-region LUS exam in a logistic regression model.

The authors reported the following findings:

• Three hundred twenty-four (16% certain ARDS) and 129 (34% certain ARDS) patients were included in the derivation and validation cohorts, 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 in certain patients of the derivation cohort and 0.80 in all patients of the validation cohort.
• Within patients with imaging–gold standard chest computed tomography available, the diagnostic accuracy of eight independent CXR readers followed the ROC curve of the LUS-ARDS score.

"Even after external validation, the LUS-ARDS score can be used to diagnose ARDS accurately," the authors concluded.

Reference:

Smit MR, Hagens LA, Heijnen NFL, Pisani L, Cherpanath TGV, Dongelmans DA, de Grooth HS, Pierrakos C, Tuinman PR, Zimatore C, Paulus F, Schnabel RM, Schultz MJ, Bergmans DCJJ, Bos LDJ; DARTS Consortium members. Lung Ultrasound Prediction Model for Acute Respiratory Distress Syndrome: A Multicenter Prospective Observational Study. Am J Respir Crit Care Med. 2023 Jun 15;207(12):1591-1601. doi: 10.1164/rccm.202210-1882OC. PMID: 36790377; PMCID: PMC10273105.