Acute Respiratory Distress Syndrome in Pregnant Women

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Rush et al1 recently presented an excellent analysis of more than 2,800 cases of acute respiratory distress syndrome in pregnancy. They comment on the limitations of the Nationwide Inpatient Sample but may understate the risks of using this administrative database.
For straightforward questions, such as rate of cesarean delivery by month, the database works.2 For complex issues, accuracy is questionable. Examples: comparison of Nationwide Inpatient Sample with chart review showed accurate indication of spinal fusion indication in only 48% of patients; comparison of Nationwide Inpatient Sample with Nationwide Surgical Quality Improvement Program showed a fivefold difference in conversion from laparoscopic to open colectomy.3,4
The authors confirm risk factors for mortality—prolonged intubation, renal failure, and amniotic fluid embolism. A stunning conclusion was a remarkably low mortality rate, less than 5% in 2012. Could transferred patients be counted twice, once at the referring hospital and again at the receiving? The authors report a combined vaginal and cesarean delivery rate of 56.6%. Were more than 40% of women really discharged undelivered?
In rare obstetric complications, huge databases have huge potential, but data validation is key. For example, we recently found less than 50% accuracy of International Classification of Diseases, 9th Revision, diagnosis of vasa previa. Until we can trust large databases, we may have to continue to learn through tedious chart review.

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