{
  "abstract": "Objectives\n\nTo determine the diagnostic accuracy of the Radiographic Assessment of Lung Edema (RALE) score for acute respiratory distress syndrome (ARDS) and its interobserver reliability.Design\n\nPost hoc analysis of a prospective observational cohort study.Setting\n\nICUs at Vanderbilt University Medical Center participating in the Validating Acute Lung Injury Biomarkers for Diagnosis study.Patients\n\nAdult patients receiving invasive ventilation for at least two consecutive days, with chest radiographs available on the first 2 ICU days.Interventions\n\nNone.Measurements and main results\n\nChest radiographs from the first 2 ICU days were scored independently by at least two experienced raters; scores were averaged per radiograph, and the highest averaged score from ICU day 1 or 2 was selected for analysis. The primary outcome was ARDS according to the Berlin definition during the first 2 ICU days. Of 236 patients, 92 (39%) had ARDS. The median RALE score was higher in patients with ARDS than in those without (29.5 [22.2-34.5] vs. 12.2 [7.5-17.8]; p < 0.01). The area under the receiver operating characteristic curve was 0.93 (95% CI, 0.90-0.96). At the optimal cutoff of 20, sensitivity was 85%, specificity 83%, positive predictive value 76%, and negative predictive value 90%. Interobserver reliability was high, with pairwise intraclass correlation coefficients ranging from 0.81 to 0.87.Conclusions\n\nIn patients invasively ventilated for at least 2 days, the RALE score demonstrated excellent diagnostic accuracy for ARDS at a cutoff of 20, together with high interobserver reliability, supporting its potential role as a standardized radiographic tool in the diagnosis of ARDS.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.",
    "Division of Intensive Care, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-j), University of Bari \"Aldo Moro,\" Bari, Italy.",
    "Department of Perioperative Medicine, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France.",
    "iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France.",
    "Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.",
    "Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.",
    "Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.",
    "Department of Anesthesia, General Intensive Care and Pain Management, Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Medical University of Vienna, Vienna, Austria.",
    "Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.",
    "Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Claudio Zimatore",
      "orcid": "0000-0002-4875-4018"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Matthieu Jabaudon",
      "orcid": "0000-0002-8121-1680"
    },
    {
      "affs": [
        1,
        4
      ],
      "name": "Luigi Pisani",
      "orcid": "0000-0001-7177-3594"
    },
    {
      "affs": [
        5
      ],
      "name": "Tatsuki Koyama"
    },
    {
      "affs": [
        0,
        4,
        6,
        7
      ],
      "name": "Marcus J Schultz",
      "orcid": "0000-0003-3969-7792"
    },
    {
      "affs": [
        8,
        9
      ],
      "name": "Lorraine B Ware",
      "orcid": "0000-0002-9429-4702"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/9kg701qht0f7m.bib",
  "cited_by": 0,
  "doi": "10.1097/cce.0000000000001495",
  "fulltext_url": "https://europepmc.org/articles/PMC13686730",
  "id": "9kg701qht0f7m",
  "issns": [
    "2639-8028"
  ],
  "landing_url": "https://europepmc.org/article/MED/42902574",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Respiratory Support and Mechanisms"
    ]
  ],
  "openalex": "W7223137915",
  "pdf_url": "https://europepmc.org/articles/PMC13686730?pdf=render",
  "pmcid": "PMC13686730",
  "pmid": "42902574",
  "published": "2026-10-21",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/9kg701qht0f7m.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:32Z",
      "native_id": "MED:42902574",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42902574"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Respiratory Support and Mechanisms",
      "subfield": "general"
    }
  ],
  "title": "Diagnostic Performance of the Radiographic Assessment of Lung Edema Score for Acute Respiratory Distress Syndrome-Post Hoc Analysis of the \"Validating Acute Lung Injury Biomarkers for Diagnosis\" Study.",
  "title_text": "Diagnostic Performance of the Radiographic Assessment of Lung Edema Score for Acute Respiratory Distress Syndrome-Post Hoc Analysis of the \"Validating Acute Lung Injury Biomarkers for Diagnosis\" Study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:32Z",
  "url": "https://research.draconitic.com/paper/9kg701qht0f7m",
  "venue": "Critical care explorations",
  "versions": []
}