Warren et al reported the Radiographic Assessment of Lung Edema (RALE) score for evaluating edema on chest X-rays. This correlates with the severity of Adult Respiratory Distress Syndrome (ARDS). The authors are from Vanderbilt University and the University of San Francisco.
Examination: PA chest X-ray
Parameters:
(1) consolidation score based on extent of alveolar opacities
(2) density score based on the density of alveolar opacities
Extent of Alveolar Opacities
Consolidation Points
none
0
1 to 24%
1
25 to 50%
2
51 to 75%
3
76 to 100%
4
Density of Alveolar Opacities
Density Points
hazy
1
moderate
2
dense
3
score for a quadrant =
= (consolidation points) * (density points)
Quadrants scored:
(1) right upper lobe
(2) right lower lobe
(3) left upper lobe
(4) left lower lobe
total RALE score =
= SUM(points for all 4 quadrants)
Interpretation:
• minimum RALE score: 0
• maximum RALE score: 48
• The higher the RALE score the more severe the ARDS.
• Survival decreases with increasing RALE scores.
• A decline in RALE scores correlates with a decline in cumulative fluid balance.
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