Accuracy of Telephone Triage in Patients Suspected of Transient Ischaemic Attack or Stroke: a Cross-sectional Study

Overview

Journal BMC Fam Pract

Publisher Biomed Central

Specialties Health Services
Public Health

Date 2020 Dec 6

PMID 33278874

Citations 4

Authors

Daphne C Erkelens

Frans H Rutten

Loes T Wouters

L Servaas Dolmans

Esther de Groot

Roger A Damoiseaux

Dorien L Zwart

Affiliations

Soon will be listed here.

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 .

Citing Articles

Safety and accuracy of digitally supported primary and secondary urgent care telephone triage in England: an observational study using routine data.

Sexton V, Grimley C, Dale J, Atherton H, Abel G BMC Med Inform Decis Mak. 2025; 25(1):52.

PMID: 39901275 PMC: 11792721. DOI: 10.1186/s12911-025-02888-x.

Additional predictors of stroke and transient ischaemic attack in BEFAST positive patients in out-of-hours emergency primary care.

van Royen F, Geersing G, Erkelens D, Delissen M, Rutten J, Zwart D PLoS One. 2024; 19(9):e0310769.

PMID: 39302942 PMC: 11414940. DOI: 10.1371/journal.pone.0310769.

Accuracy of urgency allocation in patients with shortness of breath calling out-of-hours primary care: a cross-sectional study.

Spek M, Venekamp R, de Groot E, Geersing G, Erkelens D, van Smeden M BMC Prim Care. 2024; 25(1):101.

PMID: 38539092 PMC: 10967202. DOI: 10.1186/s12875-024-02347-y.

Optimising telephone triage of patients calling for acute shortness of breath during out-of-hours primary care: protocol of a multiple methods study (Opticall).

Spek M, Venekamp R, de Groot E, Geersing G, Erkelens D, van Smeden M BMJ Open. 2022; 12(4):e059549.

PMID: 35450911 PMC: 9024277. DOI: 10.1136/bmjopen-2021-059549.

Call Characteristics of Patients Suspected of Transient Ischemic Attack (TIA) or Stroke During Out-of-Hours Service: A Comparison Between Men and Women.

Exalto L, van Doorn S, Erkelens D, Smit K, Rutten F, Kappelle L Front Neurol. 2021; 12:669090.

PMID: 34194384 PMC: 8238082. DOI: 10.3389/fneur.2021.669090.

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