TY - JOUR
T1 - Accuracy of telephone triage in patients suspected of transient ischaemic attack or stroke
T2 - a cross-sectional study
AU - Erkelens, Daphne C
AU - Rutten, Frans H
AU - Wouters, Loes T
AU - Dolmans, L Servaas
AU - de Groot, Esther
AU - Damoiseaux, Roger A
AU - Zwart, Dorien L
N1 - Funding Information:
This work was supported by (i) the department of general practice of the University Medical Center Utrecht, (ii) Associate Professorship-promotion grant of D.L. Zwart, MD, PhD, (iii) the foundation ‘Netherlands Triage Standard’ and (iv) the ‘Stoffels-Hornstra’ foundation. The views expressed are those of the authors and not necessarily those of the foundations. This research was conducted without direct involvement from both funding foundations.
Publisher Copyright:
© 2020, The Author(s).
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/12/5
Y1 - 2020/12/5
N2 - BACKGROUND: The Netherlands Triage Standard (NTS) is a widely used decision support tool for telephone triage at Dutch out-of-hours primary care services (OHS-PC), which, however, has never been validated against clinical outcomes. We aimed to determine the accuracy of the NTS urgency allocation for patients with neurological symptoms suggestive of a transient ischaemic attack (TIA) or stroke, with the clinical outcomes TIA, stroke, and other (neurologic) life-threatening events (LTEs) as the reference.METHOD: A cross-sectional study of telephone triage recordings of patients with neurological symptoms calling the OHS-PC between 2014 and 2016.The allocated NTS urgencies were derived from the electronic medical records of the OHS-PC. The clinical outcomes were retrieved from the electronic medical records of the patients' own general practitioners. The accuracy of a high NTS urgency allocation (medical help within 3 h) was calculated in terms of sensitivity, specificity, positive and negative predictive values (PPV and NPV) with the clinical outcomes TIA/stroke/other LTEs as the reference.RESULTS: Of 1269 patients, 635 (50.0%) received the diagnosis TIA/stroke (34.2% TIA/minor stroke, 15.8% major ischaemic or haemorrhagic stroke), and 4.8% other LTEs. For TIA/stroke/other LTEs, the sensitivity and specificity of the NTS urgency allocation were 0.72 (95%CI 0.68-0.75) and 0.48 (95%CI 0.43-0.52), and the PPV and NPV were 0.62 (95%CI 0.60-0.64) and 0.58 (95%CI 0.54-0.62).CONCLUSIONS: The NTS decision support tool used in Dutch OHS-PC performed poor to moderately regarding safety (sensitivity) and efficiency (specificity) in allocating adequate urgencies to patients with and without TIA/stroke/other LTEs.TRIAL REGISTRATION: The Netherlands National Trial Register, identification number NTR7331 /Trial NL7134 .
AB - BACKGROUND: The Netherlands Triage Standard (NTS) is a widely used decision support tool for telephone triage at Dutch out-of-hours primary care services (OHS-PC), which, however, has never been validated against clinical outcomes. We aimed to determine the accuracy of the NTS urgency allocation for patients with neurological symptoms suggestive of a transient ischaemic attack (TIA) or stroke, with the clinical outcomes TIA, stroke, and other (neurologic) life-threatening events (LTEs) as the reference.METHOD: A cross-sectional study of telephone triage recordings of patients with neurological symptoms calling the OHS-PC between 2014 and 2016.The allocated NTS urgencies were derived from the electronic medical records of the OHS-PC. The clinical outcomes were retrieved from the electronic medical records of the patients' own general practitioners. The accuracy of a high NTS urgency allocation (medical help within 3 h) was calculated in terms of sensitivity, specificity, positive and negative predictive values (PPV and NPV) with the clinical outcomes TIA/stroke/other LTEs as the reference.RESULTS: Of 1269 patients, 635 (50.0%) received the diagnosis TIA/stroke (34.2% TIA/minor stroke, 15.8% major ischaemic or haemorrhagic stroke), and 4.8% other LTEs. For TIA/stroke/other LTEs, the sensitivity and specificity of the NTS urgency allocation were 0.72 (95%CI 0.68-0.75) and 0.48 (95%CI 0.43-0.52), and the PPV and NPV were 0.62 (95%CI 0.60-0.64) and 0.58 (95%CI 0.54-0.62).CONCLUSIONS: The NTS decision support tool used in Dutch OHS-PC performed poor to moderately regarding safety (sensitivity) and efficiency (specificity) in allocating adequate urgencies to patients with and without TIA/stroke/other LTEs.TRIAL REGISTRATION: The Netherlands National Trial Register, identification number NTR7331 /Trial NL7134 .
UR - http://www.scopus.com/inward/record.url?scp=85097198381&partnerID=8YFLogxK
U2 - 10.1186/s12875-020-01334-3
DO - 10.1186/s12875-020-01334-3
M3 - Article
C2 - 33278874
SN - 1471-2296
VL - 21
SP - 1
EP - 10
JO - BMC Family Practice
JF - BMC Family Practice
IS - 1
M1 - 256
ER -