ArticleThe western journal of emergency medicine2025
External Validation of a Novel Lung Injury Prevention Score for the Emergency Department.
Article in The western journal of emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionDespite numerous randomized controlled trials, lung protective ventilation and prone positioning remain the only therapies shown to have a survival benefit in acute respiratory distress syndrome (ARDS). A National Heart, Lung, and Blood Institute workshop on the future of clinical research in ARDS suggested that identification of at-risk patients earlier in their clinical course would allow implementation of prevention strategies and facilitate study of these interventions. To this end, the Lung Injury Prevention Score (LIPS) was derived and validated to identify patients at risk of developing ARDS upon hospital admission, and the Emergency Department Lung Injury Prevention Score (EDLIPS) was subsequently derived and internally validated. For this study, we sought to externally validate EDLIPS.
methodsWe performed a validation study of EDLIPS, using data from a large, multicenter trial- the Vitamin D to Improve Outcomes by Leveraging Early Treatment (VIOLET) trial. After identifying patients who met VIOLET inclusion criteria while in the ED, variables comprising EDLIPS were extracted for each patient. We calculated area under the receiver operating characteristic curves (AUC) of EDLIPS for the VIOLET dataset.
resultsWe identified a total of 1,270 patients. The mean age was 56, and 55% were male. The incidence of ARDS was 8.1%. EDLIPS discriminated patients who developed ARDS from those who did not with an AUC of 0.786 (95% CI, 0.740-0.832), nearly identical to its performance in the original study, which yielded an AUC of 0.784 (95% CI, 0.748-0.820).
conclusionWe successfully validated a risk-prediction model for the identification of ED patients at risk for ARDS in a large cohort of critically ill patients. The development of ARDS prevention trials will involve collaboration with other clinical groups, such as emergency physicians, to enroll patients as early as possible in their clinical course. EDLIPS is the first tool of its kind to undergo external validation, and it can aid in the identification of ED patients at risk for the development of ARDS.
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