Can we diagnose acute respiratory distress syndrome in the emergency department?

Can We Diagnose Acute Respiratory Distress Syndrome in the Emergency Department? Objective: Current Berlin Definition criteria provides limited information about the epidemiology, diagnosis, management and outcomes of ARDS patients. In our study, we aimed to look at the ratio of emergency service physicians to recognize ARDS and determine the changes in this ratio with the training given to physicians and learn the effect of the outcome on mortality, discharge, and re-admission rates. Method: Patients who admitted to the monitored field of Emergency Department of Akdeniz University Faculty of Medicine between 01.12.2017 and 31.05.2018, with the presence of dyspnea in the last one week, pregnant and non-trauma over 18 years of age were included in the study. No additional intervention and / or treatment was performed for the patients included in the study. The emergency medicine residents were asked to record as a pre-diagnosis if the patient had ARDS. After 3 months, the physicians who participated in the study were given a lecture about the diagnosis and treatment of ARDS for 1 hour and study continued in the same way. The data collected at the end of the study were re-evaluated by the Expert with use of the Berlin Criteria. The diagnosis made by the Expert was recorded as the definitive diagnosis. Results: 400 patients were included in the last statistical analysis of the study. 202 (50.5%) of these patients were diagnosed with ARDS as a definitive diagnosis by the expert. The sensitivity and spesifity of the emergency residents' clinical diagnosis of ARDS, in patients admitting to emergency with shortness of breath in one week, is found to be 25% and 94% (p<0.0001). Inter-observer consistency between the Emergency Medical Physicians and the Expert was found to be weak. The Kappa value was calculated as 0,20048 (95% CI 0,13128 - 0,26967), ICC 0,2637 95% CI (0,1702 - 0,3526) Interobserver consistency before and after education was not statistically significant [0.045 95% CI (-0.026 – 0.117) p=0,2164]. The Kappa value was found to be 0.2319 95% CI (0.11168.3.3555) and the ICC was 0.2798 95% CI (0.141 - 0.4087). Conclusion: The rate of ARDS recognition was low by the Emergency Service Physicians and ARDS exclusion rate was found to be high. It has been observed that the education given about ARDS does not contribute to ARDS recognition rate. Key Words: ARDS Diagnosis, Berlin Criteria, Education