Table 6.
Test characteristics of physician clinical impression compared to the clinical decision instrument based on the outcome of acute critical care interventiona
| Clinician | Sensitivity | Specificity | LR+ | LR− |
|---|---|---|---|---|
| Clinical decision instrument | 114/116, 98.3% (93.9–99.5%) | 192/484, 39.7% (35.4–44.1%) | 1.63 (1.51–1.76) | 0.04 (0.01–0.17) |
| “Do you think this patient needs to be admitted to the ICU?”b | 100/111, 90.1% (83.1–94.4%) | 224/455, 49.2% (44.7–53.8%) | 1.78 (1.59–1.98) | 0.20 (0.11–0.36) |
| “In your best estimation, what is the probability of the patient requiring an ICU intervention during the first 48 hours of this patient’s hospitalization?”c | 101/111, 91.0% (84.2–95.0%) | 179/453, 39.5% (35.1–44.1%) | 1.50 (1.37–1.65) | 0.23 (0.13–0.42) |
Abbreviations: LR, likelihood ratio
The treating EM faculty was surveyed at the time of admission to evaluate clinical impression (566 of 600 patients).
Responses were reported on 566 patients. Responses marked “yes” were considered to require ICU admission and responses marked “no” were considered not to require ICU admission.
Responses were reported on 564 patients. The responses were categorized as: <1%, 1–5%, >5–10%, >10–50%, >50%, and already received a critical care intervention. Responses marked 1% or greater (or the patient already received a critical care intervention) were considered to require ICU admission and responses marked <1% were considered to not require ICU admission.