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Table 3 Validity of PHARAO alerts to detect symptoms associated with medications’ pharmacological properties during a 3-month period, by symptoms experienced by elderly patients

From: Clinical relevance of alerts from a decision support system, PHARAO, for drug safety assessment in the older adults

Experienced symptoms Sensitivity (95% CI) Specificity (95% CI) PPV (95% CI) NPV (95% CI)
According to clinical data (n) According to PHARAO alerts
  Lowest considered level of risk (n)a PHARAO alert confirmed n (%) Symptoms not identified by PHARAO n (%)     
Sedation (86) High (43) 12 (28) 74 (86) 0.14 (0.08–0.23) 0.95 (0.93–0.97) 0.28 (0.16–0.44) 0.89 (0.87–0.92)
Intermediate (60) 13 (22) 73 (85) 0.15 (0.09–0.25) 0.93 (0.90–0.95) 0.22 (0.12–0.34) 0.89 (0.87–0.91)
Low (98) 20 (20) 66 (77) 0.23 (0.15–0.34) 0.88 (0.85–0.90) 0.20 (0.13–0.30) 0.90 (0.87–0.92)
Orthostatic symptoms (90) High (38) 6 (16) 84 (93) 0.07 (0.03–0.15) 0.95 (0.93–0.97) 0.16 (0.07–0.32) 0.88 (0.85–0.90)
Intermediate (120) 19 (16) 71 (79) 0.21 (0.13–031) 0.85 (0.81–0.87) 0.16 (0.10–0.24) 0.89 (0.86–0.91)
Low (155) 24 (15) 66 (73) 0.27 (0.18–0.24) 0.80 (0.76–0.82) 0.15 (0.10–0.22) 0.89 (0.86–0.91)
Constipation (25) High (68) 9 (13) 16 (64) 0.36 (0.19–0.57) 0.92 (0.89–0.94) 0.13 (0.07–0.24) 0.98 (0.96–0.99)
Intermediate (136) 13 (10) 12 (48) 0.52 (0.32–0.72) 0.83 (0.80–0.85) 0.10 (0.05–0.16) 0.98 (0.96–0.99)
Low (249) 16 (6) 9 (36) 0.64 (0.43–0.81) 0.68 (0.64–0.71) 0.06 (0.04–0.10) 0.98 (0.96–0.99)
Anticholinergic symptoms (180) High (48) 23 (48) 157 (87) 0.13 (0.08–0.19) 0.96 (0.93–0.97) 0.48 (0.33–0.63) 0.77 (0.74–0.80)
Intermediate (130) 44 (34) 136 (76) 0.24 (0.18–0.31) 0.85 (0.81–0.88) 0.34 (0.26–0.43) 0.78 (0.74–0.81)
Low (246) 84 (34) 96 (53) 0.47 (0.39–0.54) 0.71 (0.67–0.75) 0.34 (0.28–0.40) 0.81 (0.77–0.84)
Serotonergic symptoms (63) High (11) 3 (27) 60 (95) 0.05 (0.01–0.14) 0.99 (0.98–0.99) 0.27 (0.07–0.60) 0.92 (0.89–0.94)
Intermediate (14) 4 (29) 59 (94) 0.06 (0.02–0.16) 0.98 (0.10–0.99) 0.29 (0.10–0.58) 0.92 (0.90–0.94)
Low (28) 6 (40) 57 (90) 0.10 (0.04–0.20) 0.97 (0.95–0.99) 0.21 (0.10–0.41) 0.92 (0.90–0.94)
Total (444)b High (208) 53 (25) 391 (88) 0.12 (0.09–0.15) 0.95 (0.94–0.96) 0.25 (0.20–0.32) 0.89 (0.88–0.90)
Intermediate (460) 93 (20) 351 (79) 0.21 (0.17–0.25) 0.89 (0.88–0.90) 0.20 (0.17–0.24) 0.89 (0.88–0.90)
Low (776) 150 (19) 294 (66) 0.37 (0.33–0.42) 0.78 (0.77–0.80) 0.20 (0.16–0.22) 0.90 (0.89–0.91)
  1. aThe high level of risk considers only high risk scores, intermediate level considers high and intermediate risk scores, and the low level considers high, intermediate and low risk scores. In total, 208 high, 252 intermediate, and 316 low risk alerts were found in 127, 149 and 108 patients, respectively
  2. bFound in 210 patients
  3. Abbreviations: n number, NPV negative predictive value, PPV positive predictive value, 95% CI = 95% confidence interval