Accuracy of the Chest Radiograph for the Diagnosis of Acute Respiratory Distress Syndrome (CT 4 ARDS)

Interobserver Agreement Between Chest Radiograph and Computed Tomography for the Diagnosis of Acute Respiratory Distress Syndrome

The presence of bilateral lung infiltrates on chest imaging is a mandatory criterion for the diagnosis of acute respiratory distress syndrome (ARDS). This retrospective single-center observational study assessed the agreement between chest radiograph interpreted by intensivists and chest computed tomography interpreted by radiologists for the diagnosis of ARDS in mechanically ventilated patients with hypoxemia. Chest CT was considered the reference standard. The study evaluated interobserver agreement and diagnostic performance of chest radiography in the overall population and in predefined subgroups.

Study Overview

• Status: Completed
• Conditions: Acute Respiratory Distress Syndrome (ARDS)

Detailed Description

Retrospective, single-center observational study conducted in the medical ICU of University Hospital of Poitiers, France, from January 1, 2015 to December 31, 2021. Included were intubated patients with PaO2/FiO2 ≤ 300 mmHg, PEEP ≥5 cmH2O, suspected ARDS except for imaging criterion, who underwent both chest CT and chest radiograph on the same day. Chest CT was interpreted by radiologists and used as reference for ARDS diagnosis. Chest radiographs were interpreted by intensivists. Agreement and diagnostic performance were assessed.

• Study Type: Observational
• Enrollment (Actual): 277

Contacts and Locations

Study Locations

• France
  • Poitiers, France
    • Service de Médecine Intensive Réanimation, University Hospital of Poitiers

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients admitted to the medical intensive care unit of the University Hospital of Poitiers

Description

Inclusion Criteria:

• Adults admitted to intensive care unit
• Invasive mechanical ventilation
• Chest CT performed during ICU stay
• PaO2/FiO2 ≤ 300 mmHg with positive end-expiratory pressure ≥ 5 cmH2O the day of the CT-scan
• Chest radiograph performed within ± 24h of CT-scan

Exclusion Criteria:

• Cardiogenic pulmonary edema as the cause of hypoxemia
• Missing imaging data

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cohen's kappa coefficient for agreement between chest radiograph interpreted by intensivists and chest CT interpreted by radiologists for ARDS diagnosis.	0 indicates no agreement and 1 indicates perfect agreement	Baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cohen's kappa coefficient for agreement between chest radiograph interpreted by intensivists and chest CT interpreted by radiologists for ARDS diagnosis in the subgroup of patients with moderate-to-severe hypoxemia	0 indicates no agreement and 1 indicates perfect agreement	Baseline
Cohen's kappa coefficient for agreement between chest radiograph interpreted by intensivists and chest CT interpreted by radiologists for ARDS diagnosis in the subgroup of immunocompromised patients	0 indicates no agreement and 1 indicates perfect agreement	Baseline
Cohen's kappa coefficient for agreement between chest radiograph interpreted by intensivists and chest CT interpreted by radiologists for ARDS diagnosis in the subgroup of obese patients	0 indicates no agreement and 1 indicates perfect agreement	Baseline
Cohen's kappa coefficient for agreement between chest radiograph interpreted by intensivists and chest CT interpreted by radiologists for ARDS diagnosis in the subgroup of patients with 4 quadrants involved on chest radiograph	0 indicates no agreement and 1 indicates perfect agreement	Baseline

Collaborators and Investigators

• Sponsor: Poitiers University Hospital

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2015
• Primary Completion (Actual): January 31, 2022
• Study Completion (Actual): January 31, 2022

Study Registration Dates

• First Submitted: January 30, 2026
• First Submitted That Met QC Criteria: February 6, 2026
• First Posted (Actual): February 10, 2026

Study Record Updates

• Last Update Posted (Actual): February 10, 2026
• Last Update Submitted That Met QC Criteria: February 6, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: computed tomography; sensitivity; specificity; acute respiratory distress syndrome; diagnostic imaging; chest radiograph
• Additional Relevant MeSH Terms: Immune System Diseases; Respiratory Tract Diseases; Lung Diseases; Respiration Disorders; Respiratory Distress Syndrome; Hypersensitivity
• Other Study ID Numbers: 29084890

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Data will be available on reasonable written request to the principal investigator, one year after publication of the main manuscript.
• IPD Sharing Time Frame: Start date: one year after publication of the main manuscript End date: two years after publication of the main manuscript

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No