Evaluation of telephone triage among chest pain patients in out-of-hours primary care in the Netherlands (TRACE)
© The Author(s) 2022. Published by Oxford University Press..
BACKGROUND: Telephone 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).
OBJECTIVE: To evaluate the performance of the current NTS chest pain protocol.
METHODS: Observational, 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.
RESULTS: In 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%.
CONCLUSION: Performance of telephone triage of chest pain appears moderate at best, with acceptable safety yet limited efficiency, even after including further work-up by GPs.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:40 |
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| Enthalten in: |
Family practice - 40(2023), 1 vom: 09. Feb., Seite 23-29 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Manten, Amy [VerfasserIn] |
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| Links: |
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| Themen: |
Acute coronary syndrome |
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| Anmerkungen: |
Date Completed 10.02.2023 Date Revised 13.02.2023 published: Print NTR: NL7581 Citation Status MEDLINE |
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| doi: |
10.1093/fampra/cmac077 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM343695510 |
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| 500 | |a Date Revised 13.02.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a NTR: NL7581 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2022. Published by Oxford University Press. | ||
| 520 | |a BACKGROUND: Telephone 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) | ||
| 520 | |a OBJECTIVE: To evaluate the performance of the current NTS chest pain protocol | ||
| 520 | |a METHODS: Observational, 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 | ||
| 520 | |a RESULTS: In 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% | ||
| 520 | |a CONCLUSION: Performance of telephone triage of chest pain appears moderate at best, with acceptable safety yet limited efficiency, even after including further work-up by GPs | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a acute coronary syndrome | |
| 650 | 4 | |a chest pain | |
| 650 | 4 | |a major event | |
| 650 | 4 | |a primary care | |
| 650 | 4 | |a triage | |
| 700 | 1 | |a Rietveld, Remco P |e verfasserin |4 aut | |
| 700 | 1 | |a de Clercq, Lukas |e verfasserin |4 aut | |
| 700 | 1 | |a van Hulst, Inge |e verfasserin |4 aut | |
| 700 | 1 | |a Lucassen, Wim A M |e verfasserin |4 aut | |
| 700 | 1 | |a Moll van Charante, Eric P |e verfasserin |4 aut | |
| 700 | 1 | |a Harskamp, Ralf E |e verfasserin |4 aut | |
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