Document Detail

Decision support tool for early differential diagnosis of acute lung injury and cardiogenic pulmonary edema in medical critically ill patients.
MedLine Citation:
PMID:  22030803     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: At the onset of acute hypoxic respiratory failure, critically ill patients with acute lung injury (ALI) may be difficult to distinguish from those with cardiogenic pulmonary edema (CPE). No single clinical parameter provides satisfying prediction. We hypothesized that a combination of those will facilitate early differential diagnosis.
METHODS: In a population-based retrospective development cohort, validated electronic surveillance identified critically ill adult patients with acute pulmonary edema. Recursive partitioning and logistic regression were used to develop a decision support tool based on routine clinical information to differentiate ALI from CPE. Performance of the score was validated in an independent cohort of referral patients. Blinded post hoc expert review served as gold standard.
RESULTS: Of 332 patients in a development cohort, expert reviewers (κ, 0.86) classified 156 as having ALI and 176 as having CPE. The validation cohort had 161 patients (ALI = 113, CPE = 48). The score was based on risk factors for ALI and CPE, age, alcohol abuse, chemotherapy, and peripheral oxygen saturation/Fio(2) ratio. It demonstrated good discrimination (area under curve [AUC] = 0.81; 95% CI, 0.77-0.86) and calibration (Hosmer-Lemeshow [HL] P = .16). Similar performance was obtained in the validation cohort (AUC = 0.80; 95% CI, 0.72-0.88; HL P = .13).
CONCLUSIONS: A simple decision support tool accurately classifies acute pulmonary edema, reserving advanced testing for a subset of patients in whom satisfying prediction cannot be made. This novel tool may facilitate early inclusion of patients with ALI and CPE into research studies as well as improve and rationalize clinical management and resource use.
Christopher N Schmickl; Khurram Shahjehan; Guangxi Li; Rajanigandha Dhokarh; Rahul Kashyap; Christopher Janish; Anas Alsara; Allan S Jaffe; Rolf D Hubmayr; Ognjen Gajic
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2011-10-26
Journal Detail:
Title:  Chest     Volume:  141     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-04     Completed Date:  2012-04-03     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  43-50     Citation Subset:  AIM; IM    
Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN, USA.
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MeSH Terms
Acute Lung Injury / diagnosis*,  etiology
Aged, 80 and over
Critical Illness*
Decision Support Systems, Clinical / utilization*
Decision Support Techniques*
Diagnosis, Differential
Early Diagnosis*
Follow-Up Studies
Middle Aged
Pulmonary Edema / diagnosis*,  etiology
Reproducibility of Results
Retrospective Studies
Risk Factors
Shock, Cardiogenic / complications*,  diagnosis
Grant Support

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