| Title: |
Accuracy of telephone triage in patients suspected of transient ischaemic attack or stroke: a cross-sectional study. |
| Authors: |
Erkelens, Daphne C.1 (AUTHOR) D.C.A.Erkelens@umcutrecht.nl, Rutten, Frans H.1 (AUTHOR), Wouters, Loes T.1 (AUTHOR), Dolmans, L. Servaas1 (AUTHOR), de Groot, Esther1 (AUTHOR), Damoiseaux, Roger A.1 (AUTHOR), Zwart, Dorien L.1 (AUTHOR) |
| Source: |
BMC Family Practice. 12/5/2020, Vol. 21 Issue 1, p1-10. 10p. |
| Subject Terms: |
*TRANSIENT ischemic attack diagnosis, *STROKE diagnosis, *CATASTROPHIC illness, *CONFIDENCE intervals, *DECISION support systems, *MEDICAL databases, *INFORMATION storage & retrieval systems, *EVALUATION of medical care, *MEDICAL records, *PRIMARY health care, *TELECOMMUNICATION, *MEDICAL triage, *PREDICTIVE validity, *CROSS-sectional method, *STROKE patients, *ACQUISITION of data methodology |
| Geographic Terms: |
NETHERLANDS |
| Abstract: |
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. [ABSTRACT FROM AUTHOR] |
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