(1124) ARDS Studies Published in Critical Care Journals: How Representative Are the Patients Studied?

Introduction: Minority populations have been historically underrepresented in clinical research in the United States (USA). Racial and ethnic differences in outcomes have been found in patients with acute respiratory distress syndrome (ARDS) but their representation in studies is unclear.

Methods: We performed a review of the 1,000 most cited studies about ARDS from the 5 most prominent critical care journals (by impact factor) between 2011 and 2020: the American Journal of Respiratory and Critical care medicine (AJRC), CHEST(CH), Critical Care (CC), Critical Care Medicine (CCM) and Intensive care Medicine (ICM). We included studies that had adult patients from the USA and listed demographic information in their analysis.

Results: 211 met our initial criteria but after review, only 90 manuscripts included racial and demographic information. 17 were published in AJRC, 36 in CCM, 18 in CH,11 in CC, and 8 in ICM. The average number of citations was 53 (±63). Year of publications peaked in 2015-2017 (15/year), whereas 2021 saw the lowest number of publications (1). The Median number of patients was 560 [210-1010]. There were 42 prospective studies, 29 Randomized controlled studies, and 19 retrospective cohorts. 88 studies reported patients' age (average 53 years (± 6)). 89 studies reported the number of white patients, the average was 72% (±15%). 35 studies reported only the proportion of white patients without mention of other races. 54 studies reported the proportion of black patients with an average of 19% [ range 0.3%-62.3%]. Hispanic patients were reported in 30 studies, with an average of 11 % [ range 1.2 % to 31.5%]. Asian patients were reported in 21 studies (average 5%), Native Americans in 9 studies, and multiracial in 4. 43 studies had an “other category” that was not further specified. All but one study reported gender, and there were 43% females included (range 15.8%-67%). There were no associations between studies that only reported white patient numbers, years published, number of citations, or a specific journal.

Conclusions: A substantial number of highly cited ARDS studies published in prominent critical care journals did not have detailed information regarding the racial composition of patients and a large majority included overwhelmingly white and a preponderance of male gender patients.