Radiographic criteria in ARDS.

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 syndrome. 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 records. 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.