• Amy Manten, Remco P Rietveld, Lukas de Clercq, Inge van Hulst, LucassenWim A MWAM0000-0001-5286-9400Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of General Practice, Amsterdam Cardiovascular Sciences Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands., Eric P Moll van Charante, and Ralf E Harskamp.
• Amsterdam UMC, University of Amsterdam, Academic Medical Center, Department of General Practice, Amsterdam Cardiovascular Sciences Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
• Fam Pract. 2023 Feb 9; 40 (1): 232923-29.

BackgroundTelephone triage is fully integrated in Dutch out-of-hours primary care (OOH-PC). Patients presenting with chest pain are initially assessed according to a standardized protocol ("Netherlands Triage Standard" [NTS]). Nevertheless, little is known about its (diagnostic) performance, nor on the impact of subsequent clinical judgements made by triage assistants and general practitioners (GPs).ObjectiveTo evaluate the performance of the current NTS chest pain protocol.MethodsObservational, retrospective cohort study of adult patients with chest pain who contacted a regional OOH-PC facility in the Netherlands, in 2017. The clinical outcome measure involved the occurrence of a "major event," which is a composite of all-cause mortality and urgent cardiovascular and noncardiovascular conditions, occurring ≤6 weeks of initial contact. We assessed the performance using diagnostic and discriminatory properties.ResultsIn total, 1,803 patients were included, median age was 54.0 and 57.5% were female. Major events occurred in 16.2% of patients with complete follow-up, including 99 (6.7%) cases of acute coronary syndrome and 22 (1.5%) fatal events. NTS urgency assessment showed moderate discriminatory abilities for predicting major events (c-statistic 0.66). Overall, NTS performance showed a sensitivity and specificity of 83.0% and 42.4% with a 17.0% underestimated major event rate. Triage assistants' revisions hardly improved urgency allocation. Further consideration of the clinical course following OOH-PC contact did generate a more pronounced improvement with a sensitivity of 89.4% and specificity of 61.9%.ConclusionPerformance of telephone triage of chest pain appears moderate at best, with acceptable safety yet limited efficiency, even after including further work-up by GPs.© The Author(s) 2022. Published by Oxford University Press.

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