The radiographic assessment of lung edema (RALE) score has excellent diagnostic accuracy for ARDS

Background: The chest X–ray (CXR) is part of the current ARDS definition (JAMA 2012; 307:2526) but detains poor interobserver reliability. The RALE score was recently proposed to evaluate lung edema on CXR in ARDS patients (Thorax 2018; 73: 840; figure 1A). The current study determined its diagnostic accuracy for ARDS in a cohort of ICU patients expected to need invasive ventilation for >24 hours. Methods: The current ARDS definition was used as the gold standard. The RALE score was calculated for the first available CXR. ROC curves were constructed, and the optimal cutoff was used to determine sensitivity, specificity, negative and positive predictive value of the RALE score for ARDS. Results: The study included 144 patients, of whom 33 had ARDS according to the current ARDS definition. A higher RALE score was found in patients with ARDS compared to patients without ARDS (23 [16–33] vs 7 [3–11]; P Conclusions: In this cohort of invasively ventilated ICU patients, the RALE score had an excellent diagnostic accuracy for ARDS, was easy to calculate, feasible and reliable. Additional validation of the cutoff and RALE performance is needed in larger cohorts.