Diagnostic Performance of the Radiographic Assessment of Lung Edema Score for Acute Respiratory Distress Syndrome-Post Hoc Analysis of the "Validating Acute Lung Injury Biomarkers for Diagnosis" Study
In brief
A lung-edema X-ray score detected ARDS with 85% sensitivity and 83% specificity
In 236 invasively ventilated ICU patients, a radiographic lung-edema score of 20 or higher identified acute respiratory distress syndrome with 85% sensitivity and 83% specificity; scores also showed strong agreement between experienced raters. This post hoc analysis at one medical center supports the score as a standardized diagnostic aid, but its performance needs testing in other settings.
- Journal
- Critical care explorations (Q1)
- Published
- 21 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Claudio Zimatore, Matthieu Jabaudon, Luigi Pisani, Tatsuki Koyama, Marcus J Schultz, Lorraine B Ware
- PMID
- 42902574
- DOI
- 10.1097/CCE.0000000000001495
Why clinicians should know about it
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (paper of the day, 22 October 2026): Chest radiograph score diagnostic accuracy and interobserver reliability
Abstract
OBJECTIVES: To determine the diagnostic accuracy of the Radiographic Assessment of Lung Edema (RALE) score for acute respiratory distress syndrome (ARDS) and its interobserver reliability. DESIGN: Post hoc analysis of a prospective observational cohort study. SETTING: ICUs at Vanderbilt University Medical Center participating in the Validating Acute Lung Injury Biomarkers for Diagnosis study. PATIENTS: Adult patients receiving invasive ventilation for at least two consecutive days, with chest radiographs available on the first 2 ICU days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Chest radiographs from the first 2 ICU days were scored independently by at least two experienced raters; scores were averaged per radiograph, and the highest averaged score from ICU day 1 or 2 was selected for analysis. The primary outcome was ARDS according to the Berlin definition during the first 2 ICU days. Of 236 patients, 92 (39%) had ARDS. The median RALE score was higher in patients with ARDS than in those without (29.5 [22.2-34.5] vs. 12.2 [7.5-17.8]; p < 0.01). The area under the receiver operating characteristic curve was 0.93 (95% CI, 0.90-0.96). At the optimal cutoff of 20, sensitivity was 85%, specificity 83%, positive predictive value 76%, and negative predictive value 90%. Interobserver reliability was high, with pairwise intraclass correlation coefficients ranging from 0.81 to 0.87. CONCLUSIONS: In patients invasively ventilated for at least 2 days, the RALE score demonstrated excellent diagnostic accuracy for ARDS at a cutoff of 20, together with high interobserver reliability, supporting its potential role as a standardized radiographic tool in the diagnosis of ARDS.
Abstract as published, via PubMed.
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