ArticleChest2018
Interobserver Reliability of the Berlin ARDS Definition and Strategies to Improve the Reliability of ARDS Diagnosis.
Article in Chest, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 78 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
78 citing papers in PubMed, 1 synthesis or guideline pooled it, 131 citations in OpenAlex.
- Electronic "Sniffer" Systems to Identify the Acute Respiratory Distress Syndrome.Annals of the American Thoracic Society · 2019Pooled it
- Nudging implementation of low tidal volume ventilation: a stepped wedge, cluster randomized trial.Implementation science : IS · 2026Trial
- Prophetic values of lung ultrasound score on post-extubation distress in patients with acute respiratory distress syndrome.European journal of medical research · 2022Trial
- Trial
- Clinical Characteristics and Predictors of Disease Progression in Severe Patients with COVID-19 Infection in Jiangsu Province, China: A Descriptive Study.The American journal of the medical sciences · 2020Trial
- Trial
- Improving inter-rater reliability in radiographic edema scoring in acute respiratory failure through structured training and expert feedback.ATS scholar · 2026Article
- Prone Positioning in a North American Cohort of Hypoxemic Patients on Mechanical Ventilation.Critical care medicine · 2026Observational
- Improving retrospective ARDS case-finding using a simple 72-h physiologic persistence rule.Intensive care medicine experimental · 2026Article
- Observational
- Respiratory System Compliance Predicts Outcome After Lung Transplantation-A Retrospective Single Center Study.Journal of clinical medicine · 2025Article
- Prone Positioning in a North American Cohort of Hypoxemic Patients on Mechanical Ventilation.medRxiv : the preprint server for health sciences · 2025Article
- A Computable Electronic Health Record ARDS Classifier and the Association Between theCHEST critical care · 2025Article
- Role of Attending Practice Variability in Prone Positioning Initiation: A Retrospective Cohort Study.CHEST critical care · 2025Article
- Open-source computational pipeline flags instances of acute respiratory distress syndrome in mechanically ventilated adult patients.Nature communications · 2025Article
- PET imaging of platelet derived growth factor receptor β in lung fibrosis.EJNMMI radiopharmacy and chemistry · 2025Article
- Development and External Validation of a Detection Model to Retrospectively Identify Patients With Acute Respiratory Distress Syndrome.Critical care medicine · 2025Article
- Chest radiographs in acute respiratory distress syndrome: an Achilles' heel of the Berlin criteria?Frontiers in medicine · 2025Article
- Tree-based ensemble machine learning models in the prediction of acute respiratory distress syndrome following cardiac surgery: a multicenter cohort study.Journal of translational medicine · 2024Observational
- Computational Simulation of Virtual Patients Reduces Dataset Bias and Improves Machine Learning-Based Detection of ARDS from Noisy Heterogeneous ICU Datasets.IEEE open journal of engineering in medicine and biology · 2024Article
18 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundFailure to reliably diagnose ARDS may be a major driver of negative clinical trials and underrecognition and treatment in clinical practice. We sought to examine the interobserver reliability of the Berlin ARDS definition and examine strategies for improving the reliability of ARDS diagnosis.
methodsTwo hundred five patients with hypoxic respiratory failure from four ICUs were reviewed independently by three clinicians, who evaluated whether patients had ARDS, the diagnostic confidence of the reviewers, whether patients met individual ARDS criteria, and the time when criteria were met.
resultsInterobserver reliability of an ARDS diagnosis was "moderate" (kappa = 0.50; 95% CI, 0.40-0.59). Sixty-seven percent of diagnostic disagreements between clinicians reviewing the same patient was explained by differences in how chest imaging studies were interpreted, with other ARDS criteria contributing less (identification of ARDS risk factor, 15%; cardiac edema/volume overload exclusion, 7%). Combining the independent reviews of three clinicians can increase reliability to "substantial" (kappa = 0.75; 95% CI, 0.68-0.80). When a clinician diagnosed ARDS with "high confidence," all other clinicians agreed with the diagnosis in 72% of reviews. There was close agreement between clinicians about the time when a patient met all ARDS criteria if ARDS developed within the first 48 hours of hospitalization (median difference, 5 hours).
conclusionsThe reliability of the Berlin ARDS definition is moderate, driven primarily by differences in chest imaging interpretation. Combining independent reviews by multiple clinicians or improving methods to identify bilateral infiltrates on chest imaging are important strategies for improving the reliability of ARDS diagnosis.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.