Affiliations: Morehouse School of Medicine
Harborview Medical Center
Correspondence to: Gloria E. Westney, MD, Associate Professor of Medicine, Morehouse School of Medicine, 720 Westview Dr, SW, Atlanta, GA 30310
To the Editor:
The article by Rubenfeld et al in a recent issue of
CHEST (November 1999)1 highlighted a key
problem when applying clinical parameters to the definition of a
In the daily care of an ARDS patient, physicians of various specialties
and other health-care personnel are often the first individuals
reviewing the chest x-ray (CXR). However, it is the interpretation from
the radiology department that is officially used in the patient
One useful modification to the CXR criteria may be to specify that the
official radiographic interpretation by a radiologist be used in the
definition of ARDS. Perhaps we also need to develop and validate more
explicit and concrete CXR criteria within the discipline of radiology
so as to eliminate interobserver variability.2
Developing explicit and reproducible diagnostic criteria is
the only way we can apply the American-European Consensus Conference
definition to research protocols among multiple study centers.
We agree with the comments by Dr. Westney. As discussed
in our article, we believe that the solution to the interobserver
variability problem in the radiographic definition of ARDS is more
explicit definitions that have been subjected to empiric validation. It
is particularly important that any subsequent attempt to operationalize
this definition be accompanied by example radiographs.
As data become available showing improved outcome from various
interventions in patients with acute lung injury and ARDS, it will be
essential for clinicians at the bedside to be able to identify the same
patients in the same time frame as those who benefited from the
Become a CHEST member and receive a FREE subscription as a benefit of membership.
Individuals can purchase this article on ScienceDirect.
Individuals can purchase a subscription to the journal.
Individuals can purchase a subscription to the journal or buy individual articles.
Learn more about membership or Purchase a Full Subscription.
Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.