Accuracy of urgency allocation in patients with shortness of breath calling out-of-hours primary care : a cross-sectional study
© 2024. The Author(s)..
BACKGROUND: In out-of-hours primary care (OHS-PC), semi-automatic decision support tools are often used during telephone triage. In the Netherlands, the Netherlands Triage Standard (NTS) is used. The NTS is mainly expert-based and evidence on the diagnostic accuracy of the NTS' urgency allocation against clinically relevant outcomes for patients calling with shortness of breath (SOB) is lacking.
METHODS: We included data from adults (≥18 years) who contacted two large Dutch OHS-PC centres for SOB between 1 September 2020 and 31 August 2021 and whose follow-up data about final diagnosis could be retrieved from their own general practitioner (GP). The diagnostic accuracy (sensitivity and specificity with corresponding 95% confidence intervals (CI)) of the NTS' urgency levels (high (U1/U2) versus low (U3/U4/U5) and 'final' urgency levels (including overruling of the urgency by triage nurses or supervising general practitioners (GPs)) was determined with life-threatening events (LTEs) as the reference. LTEs included, amongst others, acute coronary syndrome, pulmonary embolism, acute heart failure and severe pneumonia.
RESULTS: Out of 2012 eligible triage calls, we could include 1833 adults with SOB who called the OHS-PC, mean age 53.3 (SD 21.5) years, 55.5% female, and 16.6% showed to have had a LTE. Most often severe COVID-19 infection (6.0%), acute heart failure (2.6%), severe COPD exacerbation (2.1%) or severe pneumonia (1.9%). The NTS urgency level had a sensitivity of 0.56 (95% CI 0.50-0.61) and specificity of 0.61 (95% CI 0.58-0.63). Overruling of the NTS' urgency allocation by triage nurses and/or supervising GPs did not impact sensitivity (0.56 vs. 0.54, p = 0.458) but slightly improved specificity (0.61 vs. 0.65, p < 0.001).
CONCLUSIONS: The semi-automatic decision support tool NTS performs poorly with respect to safety (sensitivity) and efficiency (specificity) of urgency allocation in adults calling Dutch OHS-PC with SOB. There is room for improvement of telephone triage in patients calling OHS-PC with SOB.
TRIAL REGISTRATION: The Netherlands Trial Register, number: NL9682.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:25 |
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| Enthalten in: |
BMC primary care - 25(2024), 1 vom: 27. März, Seite 101 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Spek, Michelle [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Completed 29.03.2024 Date Revised 29.03.2024 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1186/s12875-024-02347-y |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM370286367 |
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| 100 | 1 | |a Spek, Michelle |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Accuracy of urgency allocation in patients with shortness of breath calling out-of-hours primary care |b a cross-sectional study |
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| 500 | |a Date Revised 29.03.2024 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2024. The Author(s). | ||
| 520 | |a BACKGROUND: In out-of-hours primary care (OHS-PC), semi-automatic decision support tools are often used during telephone triage. In the Netherlands, the Netherlands Triage Standard (NTS) is used. The NTS is mainly expert-based and evidence on the diagnostic accuracy of the NTS' urgency allocation against clinically relevant outcomes for patients calling with shortness of breath (SOB) is lacking | ||
| 520 | |a METHODS: We included data from adults (≥18 years) who contacted two large Dutch OHS-PC centres for SOB between 1 September 2020 and 31 August 2021 and whose follow-up data about final diagnosis could be retrieved from their own general practitioner (GP). The diagnostic accuracy (sensitivity and specificity with corresponding 95% confidence intervals (CI)) of the NTS' urgency levels (high (U1/U2) versus low (U3/U4/U5) and 'final' urgency levels (including overruling of the urgency by triage nurses or supervising general practitioners (GPs)) was determined with life-threatening events (LTEs) as the reference. LTEs included, amongst others, acute coronary syndrome, pulmonary embolism, acute heart failure and severe pneumonia | ||
| 520 | |a RESULTS: Out of 2012 eligible triage calls, we could include 1833 adults with SOB who called the OHS-PC, mean age 53.3 (SD 21.5) years, 55.5% female, and 16.6% showed to have had a LTE. Most often severe COVID-19 infection (6.0%), acute heart failure (2.6%), severe COPD exacerbation (2.1%) or severe pneumonia (1.9%). The NTS urgency level had a sensitivity of 0.56 (95% CI 0.50-0.61) and specificity of 0.61 (95% CI 0.58-0.63). Overruling of the NTS' urgency allocation by triage nurses and/or supervising GPs did not impact sensitivity (0.56 vs. 0.54, p = 0.458) but slightly improved specificity (0.61 vs. 0.65, p < 0.001) | ||
| 520 | |a CONCLUSIONS: The semi-automatic decision support tool NTS performs poorly with respect to safety (sensitivity) and efficiency (specificity) of urgency allocation in adults calling Dutch OHS-PC with SOB. There is room for improvement of telephone triage in patients calling OHS-PC with SOB | ||
| 520 | |a TRIAL REGISTRATION: The Netherlands Trial Register, number: NL9682 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Netherlands triage standard | |
| 650 | 4 | |a Out-of-hours primary care | |
| 650 | 4 | |a Shortness of breath | |
| 650 | 4 | |a Telephone triage | |
| 700 | 1 | |a Venekamp, Roderick P |e verfasserin |4 aut | |
| 700 | 1 | |a de Groot, Esther |e verfasserin |4 aut | |
| 700 | 1 | |a Geersing, Geert-Jan |e verfasserin |4 aut | |
| 700 | 1 | |a Erkelens, Daphne C A |e verfasserin |4 aut | |
| 700 | 1 | |a van Smeden, Maarten |e verfasserin |4 aut | |
| 700 | 1 | |a Dobbe, Anna S M |e verfasserin |4 aut | |
| 700 | 1 | |a Delissen, Mathé |e verfasserin |4 aut | |
| 700 | 1 | |a Rutten, Frans H |e verfasserin |4 aut | |
| 700 | 1 | |a Zwart, Dorien L |e verfasserin |4 aut | |
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