• Bmc Fam Pract · Dec 2020

    Accuracy of telephone triage in patients suspected of transient ischaemic attack or stroke: a cross-sectional study.

    • Daphne C Erkelens, Frans H Rutten, Loes T Wouters, L Servaas Dolmans, Esther de Groot, Roger A Damoiseaux, and Dorien L Zwart.
    • Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, STR 6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands. D.C.A.Erkelens@umcutrecht.nl.
    • Bmc Fam Pract. 2020 Dec 5; 21 (1): 256.

    BackgroundThe 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.MethodA 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.ResultsOf 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).ConclusionsThe 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 RegistrationThe Netherlands National Trial Register, identification number NTR7331 /Trial NL7134 .

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