• Michelle Spek, Roderick P Venekamp, Anne A H de Hond, Esther de Groot, Geert-Jan Geersing, Anna Sm Dobbe, Mathé Delissen, Frans Rutten, Maarten Smeden, and Dorien Zwart.
• University Medical Centre Utrecht, Department of General Practice & Nursing Sciences, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands m.spek-3@umcutrecht.nl.
• Br J Gen Pract. 2025 Jan 21.

AimTo develop and internally validate a model predicting life-threatening events for out-of-hours primary care callers with shortness of breath.MethodThis cross-sectional study includes data from 1,952 patients with shortness of breath who called out-of-hours primary care between September 2020 and August 2021. Four logistic regression models were developed with life-threatening events as the outcome. We started with a model of age and gender (model 1) and successively added call characteristics (calling at night and someone else calling on behalf of the patient; model 2), symptoms (cough, fever, inability to speak full sentences and wheezing; model 3), and medical history and medication use (cardiovascular and/or pulmonary; model 4). The models were internally validated using optimism correction via bootstrap with 1000 repetitions. Performance measures of discrimination (c-statistic) and calibration (calibration intercept and slope) were determined.ResultsApproximately 17% of callers with shortness of breath had a life-threatening event. Model 3 performed best. This model exhibited good discriminative ability (internal validation c-statistic of 0.764 (95% CI: 0.739 to 0.792)) and was well calibrated. All models had a high net benefit compared to using no model. Models 3 and 4 had a higher net benefit compared with models 1 and 2. As models 3 and 4 were similar in terms of net benefit, the model with fewer parameters (model 3) is preferred.ConclusionA prediction model consisting of age, gender, call characteristics, and symptoms holds promise for improving telephone triage of callers to out-of-hours primary care with shortness of breath.Copyright © 2025, The Authors.

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