ArticleIntensive care medicine experimental2026
Improving retrospective ARDS case-finding using a simple 72-h physiologic persistence rule.
Article in Intensive care medicine experimental, 2026. 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
backgroundRetrospective studies frequently use single-time-point Berlin physiologic criteria (PaO
methodsWe conducted a retrospective cohort study using the MIMIC-IV database (2008-2019) for derivation and a UK ICU dataset (Imperial College Healthcare National Health Service Trust, 2009-2024) for external validation. All patients meeting Berlin physiologic criteria for at least 72 h were identified. From MIMIC-IV, we randomly selected 2000 patients who met 72-h persistence criteria for expert adjudication based on detailed review of clinical notes, imaging, and echocardiography, classifying them as ARDS, non-ARDS acute hypoxaemic respiratory failure, or possible ARDS. Sensitivity analyses with shorter durations (≥ 24 and ≥ 48 h) were performed. Diagnostic performance of radiology keyword searches and ARDS-specific ICD-9/10 codes were compared to expert adjudication.
resultsOf 18,621 patients who ever met physiologic criteria, 3940 met the 72-h persistence threshold. In a random sample of 2000 from this 72-h MIMIC-IV cohort, expert adjudication identified ARDS in 49.7% (95% CI, 48-52%); in the external UK validation cohort, 56% (95% CI, 46-66%) were adjudicated as ARDS. ARDS prevalence significantly declined with shorter persistence requirements: 21% after 48 h, 8% after 24 h, and 6% with single isolated measurements. Within the 72-h persistence criterion enriched sample, the highest performing radiology keyword search set provided limited sensitivity (49%) and moderate specificity (76%), whereas ICD codes had higher sensitivity (76%) but low specificity (47%).
conclusionsBerlin physiologic criteria alone were inadequate for retrospective ARDS identification. A ≥ 72-h persistence rule improved cohort enrichment but did not define ARDS, with substantial residual misclassification remaining after physiologic screening. Persistence should therefore be viewed as a pragmatic enrichment strategy rather than a definitive retrospective ARDS label.
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