Background: The anatomical feature of ARDS is to diffuse alveolar damage (DAD) but the correlation between the American European Consensus Conference (AECC) definition of ARDS and DAD has not been studied in Pediatrics. Aim: To compare the AECC definition of ARDS to autopsy findings. Methods: Retrospective matching study of autopsies conducted at Hospital La Misericordia between 2000 - 2010 (n 355). The findings of the histopathological and clinical history was processed by calculating sensitivity, specificity and likelihood ratio considering the pulmonary and extrapulmonary risk factors. Results: The sensitivity of clinical criteria is 64.4 (95 % CI) and specificity 71 (95 % CI), with (LR)+=2.2 and LR (-) 0.5 . With intrapulmonary risk factors, the sensitivity is 80 (95 % CI) and specificity 50 (95 %) with an LR (+) of 1.6 and an LR (-) of 0.4. With extrapulmonary risk factors, the sensitivity is 55 (95 % CI) and specificity 84 (95 %) with LR + of 3.43 and LR- of 0.53. Conclusions: The clinical AECC criteria adequately discriminate patients with DAD and extrapulmonary risk factors, but not in the case where the factor is pulmonary. An adequate contribution of this study is that stratification is done based on the risk factors. Despite the limitations of the AECC definition, they are still valuable since patients will benefit from the proposed treatments even if they do not have DAD.