To the Editor The article by Dr Bellani and colleagues1 did not describe the role of the clinicians treating patients with ARDS in the study, in particular whether they knew if their skills diagnosing ARDS were being tested. This is relevant to a conclusion drawn by authors in the discussion section. If clinicians were aware of the study purpose (based on the fact that they were asked about ARDS at 2 separate times in the study), then the conclusion that ARDS might have been underrecognized in the study may not be correct. If physicians were conscious of being evaluated for their diagnostic skills, they would be less likely to miss the diagnosis and instead would overdiagnose it. Thus, clinician recognition of ARDS in the study might have occurred more frequently than it would in real-world clinical practice.
Zafar K. Incidence of Acute Respiratory Distress Syndrome. JAMA. 2016;316(3):347. doi:10.1001/jama.2016.6468