Table 6.
Adjusted sensitivity of each clinical decision rule taking into consideration of outcomes known at Day 2 reassessment and details of missed outcomes for episodes classified as low risk (outpatient onset FN only, n = 689). Details of missed bacteraemia episodes after Day 2 assessment are available in online supplement.
| Rule (number low risk) | Adjusted Day 2 Se. (95% CI)^ | Missed outcomes in low-risk group |
Other outcomes in low-risk group |
|||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Missed outcomes, n (%) | Median time to diagnosis, h (IQR)* | Known at Day 2, n (%) | Bacteraemia n (%) |
ICU admission, n (%) | Late onset severe sepsis, n (%) | 30 day mortality, n (%) | Median LOS, days (IQR) | |||
| All | >Day2 | |||||||||
| Rules predicting microbiologically defined infection | ||||||||||
| PICNICC [8] (140) | 90·7 (86·3–93·8) | 33 (23·6) | 42.3 (19·2–52·4) | 11 (33·3) | 7 (5·0) | 5 (3·6) | 0 | 0 | 0 | 3·0 (2·1–4·7) |
| Rules predicting adverse outcome | ||||||||||
| SPOG-AE [21] (309) | NA | 114 (36·9)⁎⁎ | 31·9 (12·9–53·4) | 41 (36·0) | 22 (7·1)⁎⁎ | 17 (5·5) | 1⁎⁎⁎ (0·3) | 0 | 2 (0·6) | 3·9 (2·5–7·0) |
| Hakim [22] (589) | 68·0 (58·4–76·2) | 65 (11·0) | 23·7 (17·1–39·0) | 32 (49·2) | 49 (8·3) | 28 (4·8) | 2⁎⁎⁎ (0·3) | 1⁎⁎⁎ (0·2) | 2 (0·3) | 4·1 (2·7–7·1) |
| Alexander [23] (354) | 69·0 (62·9–74·6) | 111 (31·4) | 37·6 (15·7–62·2) | 37 (33·3) | 29 (8·2) | 13 (3·7) | 2 (0·6) | 2 (0·6) | 0 | 3·9 (2·7–6·8) |
| Klaassen [24] (187) | 90·7 (83·3–95·0) | 18 (9·6) | 36·6 (8·9–59·3) | 9 (50) | 8 (4·3) | 4 (2·1) | 0 | 0 | 0 | 2·9 (2·0–4·1) |
| Rules predicting bacteraemia | ||||||||||
| SPOG-bact [28] (137) | NA | 9 (6·6)⁎⁎ | 27·8 (17·0–42·4) | 3 (33·3) | 9 (6·6) | 6 (4·4) | 1⁎⁎⁎ | 0 | 0 | 4·5 (2·6–6·8) |
| Ammann [27] (139) | 96·0 (88·9–98·9) | 5 (3·6) | 26·6 (5·9–46·1) | 2 (40) | 5 (3·6) | 3 (2·2) | 0 | 0 | 0 | 2·9 (2·0–4·2) |
| Baorto [25] (135) | 96·0 (88·9–98·9) | 6 (4·4) | 31·5 (8·5–66·6) | 3 (50) | 6 (4·4) | 3 (2·2) | 0 | 0 | 0 | 2·8 (2·0–3·7) |
| Rackoff [26] (low & int 547) | 67·7 (55·4–76·3) | 45 (8·2) | 23·6 (16·9–37·1) | 20 (44·4) | 45 (8·2) | 25 (4·6) | 5 (0·9)# | 1 (0·2)#,⁎⁎⁎ | 2 (0·4)# | 4·2 (2·7–7·2) |
Se, sensitivity; h, hour; IQR, interquartile range; ICU, intensive care unit; LOS, length of stay; AE, adverse event.
^
using SPOG methodology.
⁎
For composite outcomes the time to diagnosis of first outcome was used.
⁎⁎
data presented for missed episodes at FN presentation.
⁎⁎⁎
Outcome known prior to day 2 assessment.
#
all missed episodes were classified as intermediate risk and ICU admission known prior to day 2 assessment in 3 out of 5.