Development and testing of a modified clinical definition of the acute respiratory distress syndrome

There is no gold standard available for the diagnosis of Acute Respiratory Distress Syndrome (ARDS). The validity and reliability of the current definition proposed by the American-European Consensus Conference (AECC) on ARDS have been questioned. In this study a modified definition of ARDS was developed using the Delphi technique. Definition testing was carried out in the form of sensibility testing using a separate expert panel and applying a questionnaire to both the AECC and modified definitions. Both definitions were found to have poor to moderate sensibility and explicit feedback for improvement was generated for both definitions. A local panel employed these suggestions to the modified definition, resulting in the revised modified ARDS definition. It is concluded that formal consensus techniques and rigorous methodology can be applied to the derivation and testing of ARDS definitions. Further testing of sensibility and reliability are needed for both definitions after appropriate revisions are made.