Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Among patients with ARDS, a reduction in RALE score in the first three days following onset was associated with decreased mortality at 90-days.

Evidence level Rating: 2 (Good)

The development of acute respiratory distress syndrome (ARDS) among critically ill patients portends significant morbidity and mortality. Non-invasive tests like the Radiographic Assessment of Lung Edema (RALE) score have been developed to characterize pulmonary edema in ARDS based on the extent and density of alveolar opacities seen on chest X-ray. The RALE score is based on the sum product of consolidation and density scores for each quadrant on imaging, with 48 being the maximal score. The purpose of this retrospective cohort study was to assess whether early changes in RALE score among patients with ARDS is associated with a decrease in 90-day mortality. Chest X-rays were available for 135 patients at baseline, 64 patients on day two, and 88 patients on day three. Of the 135 patients at baseline, 89 patients (mean [SD] age = 57 [15] years, 71% male) survived while 46 patients (mean [SD] age = 68 [14] years, 83% male) did not. It was found that baseline RALE score (HR for each one-point increment 1.04, 95% CI 1.01 to 1.08, p = 0.006) and the change in RALE score over time (HR for each one-point decrease in RALE score per unit of time 0.99, 95% CI, 0.99 to 0.99, p = 0.03) were independently associated with death at 90 days, even after adjusting for age, sex, BMI, vasopressor use, and total volume of fluids received. When comparing an absolute increase or no change in RALE score from baseline to day three to a decrease in RALE score over the same period, a higher risk of death at 90 days was observed (HR 3.39, 95% CI 1.14 to 10.09, p = 0.03). This study found that an early decrease in RALE score was associated with a decreased risk of mortality at 90 days among patients with ARDS. Such findings illustrate how serial chest X-ray imaging among such patients may be useful as a non-invasive prognostic marker of clinical outcomes.

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