Evidence map›Paper›PMID 41467760›Full record

Observational studyCritical care medicine2026

An Electronic Health Record-Based Classifier for Moderate-to-Severe Acute Respiratory Distress Syndrome With Persistent Hypoxemia.

Chad H Hochberg, Anna K Barker, Alhareth Alsagban, Sophia Emetu, Bhavna Seth, Olive Tang, Shavin Thomas, Kevin J Psoter, Michelle N Eakin, Michael W Sjoding and 2 more

Abstract readObservational StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Critical care medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Observational
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Chad H HochbergDivision of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University, Baltimore, MD.ORCID 0000-0002-4376-5754
Anna K BarkerDivision of Pulmonary and Critical Care, Department of Medicine, University of Michigan, Ann Arbor, MI.
Alhareth AlsagbanDepartment of Medicine, Johns Hopkins University, Baltimore, MD.
Sophia EmetuDepartment of Medicine, Johns Hopkins University, Baltimore, MD.
Bhavna SethDivision of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
Olive TangDepartment of Medicine, Johns Hopkins University, Baltimore, MD.
Shavin ThomasDepartment of Medicine, Johns Hopkins University, Baltimore, MD.
Kevin J PsoterDepartment of Pediatrics, Johns Hopkins University, Baltimore, MD.
Michelle N EakinDivision of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University, Baltimore, MD.
Michael W SjodingDivision of Pulmonary and Critical Care, Department of Medicine, University of Michigan, Ann Arbor, MI.
Theodore J IwashynaDivision of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University, Baltimore, MD.
David N HagerDivision of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University, Baltimore, MD.

Funding

Sustainable Implementation of Prone Positioning for the Acute Respiratory Distress SyndromeK23HL169743 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI Chad Hochberg · 2023 to 2026
$716k
NHLBI NIH HHS K23 HL169743
6 · The paper itself

Abstract

objectivesTo characterize the performance of an electronic health record (EHR) data-based classifier of persistent moderate-to-severe acute respiratory distress syndrome (ARDS).

designRetrospective observational study.

settingSix ICUs from two health systems. PATIENTS: We included adults receiving greater than or equal to 24 hours of invasive mechanical ventilation (IMV) with a Pa o2 /F io2 of less than or equal to 150 mm Hg on F io2 greater than or equal to 0.6 in the first 72 hours of IMV. We evaluated classifier performance in two temporally and geographically distinct cohorts: a development cohort including patients in one of two academic medical or three mixed community ICUs in the first 3 months of 2021 or in 2022-2023, and a validation cohort from a different academic medical ICU in 2017.

interventionsNone. MEASUREMENTS AND MAIN

resultsIn both cohorts, study physicians assessed patients for clinical ARDS criteria. We retrospectively applied the EHR classifier, which required a persistent Pa o2 /F io2 of less than or equal to 150 mm Hg or receipt of interventions to address severe hypoxemia (i.e., prone positioning, neuromuscular blockade, inhaled pulmonary vasodilators) in the 24 hours after initially meeting hypoxemia criteria. We also evaluated classifier definitions that used peripheral oxygen saturation (Sp o2 )/F io2 of less than or equal to 162 to indicate persistent hypoxemia. Of 924 patients in the development cohort, 504 (55%) had clinician-adjudicated ARDS. Of 90 patients in the validation cohort, 48 (53%) had clinician-adjudicated ARDS. In the development and validation cohorts, the primary EHR-based classifier identified 382 and 38 patients as having persistent moderate-to-severe ARDS, respectively (positive predictive value [PPV], 71%; 95% CI, 66-75% and PPV, 66%; 95% CI, 50-81%). When Sp o2 /F io2 was used as the second hypoxemia marker more patients were classified as ARDS in both development and validation cohorts but with lower PPVs (67% and 62%, respectively.).

conclusionsAn EHR-based classifier using readily available data had acceptable performance for identifying patients with persistent moderate-severe ARDS. This open-source tool could be used for retrospective or prospective identification of this vulnerable population for research and quality improvement initiatives.

Indexed as

Electronic Health RecordsHypoxiaRespiratory Distress SyndromeAdultAgedFemaleHumansIntensive Care UnitsMaleMiddle AgedRespiration, ArtificialRetrospective StudiesSeverity of Illness Indexadult respiratory distress syndromeinformatics

Identifiers

PMID41467760
PMCPMC13093225

What OpenQuestion holds

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Registered trials

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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.