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Table 4 Validation and refinement of the spectrum score method to measure antimicrobial de-escalation

From: Description and validation of a spectrum score method to measure antimicrobial de-escalation in healthcare associated pneumonia from electronic medical records data

Validation exercise Sensitivity (%) Specificity (%) Positive predictive value (%) Negative predictive value (%) Comments
Convergent validation of original spectrum score 86.3 96.0 87.5 95.6 Reference standard de-escalation prevalence in vignettes was 24.2%. Route of administration data not included in cases. Mean Likert score was 0.51 points higher for cases where regimens contained ≥ 1 antimicrobial available in a PO dosage form administered on day 4 (p = 0.003).
Refinement exercise to verify that IV to PO conversion impacted expert opinion of de-escalation events NA NA NA NA Mean Likert scores for regimens containing similar antimicrobials but differing routes of administration by day 4 was 5.0 (1.5) and 4.6 (1.5) for PO and IV cases (P = 0.002), respectively. Linear regression used to estimate an additional credit to the spectrum score ∆ to account for the group mean differences in Likert score associated with conversion from IV to PO therapy. A 6 point credit was added to spectrum score ∆ values for regimens with >50-100% PO and 3 point credit for regimens >0 but < 50% PO.
Convergent validation of spectrum score method including PO offsets 96.2 93.6 94.4 95.7 Reference standard de-escalation prevalence in vignettes was 53.0%. Route of administration data included in cases and PO credits applied to spectrum score ∆.