Accuracy of telephone triage in patients suspected of transient ischaemic attack or stroke: a cross-sectional study

Erkelens, Daphne Carmen; Rutten, Frans H.; Wouters, Loes; Dolmans, L. Servaas; Groot, Esther de; Damoiseaux, Roger; Zwart, Dorien

doi:10.1186/s12875-020-01334-3

Cited by 6 publications

(13 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A limitation was missing data on the final clinical outcome (35% of all relistened recordings). However, a previous detailed comparison in patient characteristics between those with a final diagnosis and those without showed that these groups were comparable (i.e., no indication of selection bias) (16). Therefore, we believe our results are generalizable to similar OHS-PC settings.…”

Section: Discussionsupporting

confidence: 51%

“…Neurological deficits may also be caused by multiple other (less urgent) disorders. Not surprisingly, the NTS decision support tool used in Dutch OHS-PC performs moderately regarding sensitivity and specificity in allocating adequate urgencies to patients with and without TIA/stroke (16). Literature on this topic is scarce.…”

Section: Discussionmentioning

confidence: 99%

“…A detailed description of the ICPC codes, medical keywords, and inclusion and exclusion criteria has been published elsewhere (15). We selected and relistened a random sample of 1,953 calls, and in 1,266 of these, we were able to retrieve the final diagnosis via the patient's GP (16).…”

Section: Design and Settingmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background: In the Netherlands, a digital decision support system for telephone triage at out-of-hours services in primary care (OHS-PC) is used. Differences in help-seeking behavior between men and women when transient ischemic attack (TIA) or stroke is suspected could potentially affect telephone triage and allocation of urgency.Aim: To assess patient and call characteristics and allocated urgencies between women and men who contacted OHS-PC with suspected TIA/stroke.Methods: A cross-sectional study of 1,266 telephone triage recordings of subjects with suspected neurological symptoms calling the OHS-PC between 2014 and 2016. The allocated urgencies were derived from the electronic medical records of the OHS-PC and the final diagnosis from the patient's own general practitioner, including diagnoses based on hospital specialist letters.Results: Five hundred forty-six men (mean age = 67.3 ± 17.1) and 720 women (mean age = 69.6 ± 19.5) were included. TIA/stroke was diagnosed in 294 men (54%) (mean age = 72.3 ± 13.6) and 366 women (51%) (mean age = 78.0 ± 13.8). In both genders, FAST (face-arm-speech test) symptoms were common in TIA/stroke (men 78%, women 82%) but also in no TIA/stroke (men 63%, women 62%). Men with TIA/stroke had shorter call durations than men without TIA/stroke (7.10 vs. 8.20 min, p = 0.001), whereas in women this difference was smaller and not significant (7.41 vs. 7.56 min, p = 0.41). Both genders were allocated high urgency in 75% of the final TIA/stroke cases.Conclusion: Overall, patient and call characteristics are mostly comparable between men and women, and these only modestly assist in identifying TIA/stroke. There were no gender differences in allocated urgencies after telephone triage in patients with TIA/stroke.

show abstract

Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…17 It is also higher than the reported accuracy of telephone triage for patients with suspected cerebral vascular accidents. 18 Sensitivity of telephone triage was higher for outcomes at three and seven days (Supplementary Material 4), and sensitivity appeared to be increased at the expense of specificity in the later period of clinical assessment pathway implementation (Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…Different models for telephone triage in urgent and emergency care exist internationally. 18 32 33 NHS 111’s use of trained, non-clinical call advisors for initial assessment contrasts with other national triage services where assessments are performed by nurses and other clinicians. 33 As as been previously recommended, research is needed to determine the optimal configuration of such services in terms of accuracy and cost-effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of telephone triage for predicting adverse outcome in suspected COVID-19: An observational cohort study

Marincowitz

Stone

Bath

et al. 2021

Preprint

View full text Add to dashboard Cite

Objective: To assess accuracy of telephone triage in identifying patients who need emergency care amongst those with suspected COVID-19 infection and identify factors which affect triage accuracy. Design: Observational cohort study Setting: Community telephone triage in the Yorkshire and Humber, Bassetlaw, North Lincolnshire and North East Lincolnshire region. Participants: 40, 261 adults who contacted NHS 111 telephone triage services provided by Yorkshire Ambulance Service NHS Trust between the 18th March 2020 and 29th June 2020 with symptoms indicating possible COVID-19 infection were linked to Office for National Statistics death registration data, hospital and general practice electronic health care data collected by NHS Digital. Outcome: Accuracy of triage disposition (self-care/non-urgent clinical assessment versus ambulance dispatch/urgent clinical assessment) was assessed in terms of death or need for organ support at 30, 7 and 3 days from first contact with the telephone triage service. Results: Callers had a 3% (1, 200/40, 261) risk of adverse outcome. Telephone triage recommended self-care or non-urgent assessment for 60% (24, 335/40, 261), with a 1.3% (310/24, 335) risk of subsequent adverse outcome. Telephone triage had 74.2% sensitivity (95% CI: 71.6 to 76.6%) and 61.5% specificity (61% to 62%) for adverse outcomes at 30 days from first contact. Multivariable analysis suggested some co-morbidities (such as chronic respiratory disease) may be over-estimated as predictors of adverse outcome, while the association of diabetes with adverse outcome may be under-estimated. Repeat contact with the service appears to be an important under recognised predictor of adverse outcomes with both 2 contacts (OR 1.77 95% CI: 1.14 to 2.75) and 3 or more contacts (OR 4.02 95% CI: 1.68 to 9.65) associated with clinical deterioration when not provided with an ambulance or urgent clinical assessment. Conclusion: Patients advised to self-care or receive non-urgent clinical assessment had a small but non-negligible risk of serious clinical deterioration. The sensitivity and specificity of telephone triage was comparable to other tools used to triage patient acuity in emergency and urgent care. Repeat contact with telephone services needs recognition as an important predictor of subsequent adverse outcomes.

show abstract

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

et al. 2022

Self Cite

View full text Add to dashboard Cite

IntroductionCallers with acute shortness of breath (SOB) are a challenge for telephone triage at out-of-hours primary care (OHS-PC) as SOB could be the sign of a potentially life-threatening disease, yet mostly is a symptom of a broad range of self-limiting disorders. Current telephone triage practice is mainly expert based and clear evidence on accuracy, safety and efficiency of the use of the Netherlands Triage Standard (NTS) by triage nurses based on the eventual clinical outcome is lacking for this domain.Methods and data analysisMultiple methods study in five OHS-PC services in the Utrecht region, the Netherlands. Data will be collected from OHS-PC electronic health records (EHR) and backed up tapes of telephone triage conversations, which will be linked to routine primary care EHR data. In cross-sectional studies, we will (1) validate the NTS urgency classification for adults with SOB against final diagnoses and (2) develop diagnostic prediction models for urgent diagnoses (eg, composite endpoint of urgent diagnoses, pulmonary embolism, acute coronary syndrome, acute heart failure and pneumonia). We will develop improvement measures for the use of the NTS by triage nurses through practice observations and semistructured interviews with patients, triage nurses and general practitioners (GPs). In an action research approach, we will, in collaboration with these stakeholders, implement and evaluate our findings in both GP and triage nurse educational programmes as well as in OHS-PC services.Ethics and disseminationThe Medical Ethics Review Committee Utrecht, the Netherlands, approved the study protocol (protocol 21/361). We will take into account the ‘code of conduct for responsible research’ of the WHO, the EU General Data Protection Regulation and the ‘Dutch Medical Treatment Contracts Act’. Results will be disseminated in peer-reviewed publications and at (inter)national meetings.Trial registration numberNL9682.

show abstract

Accuracy of telephone triage in patients suspected of transient ischaemic attack or stroke: a cross-sectional study

Cited by 6 publications

References 42 publications

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

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

Accuracy of telephone triage for predicting adverse outcome in suspected COVID-19: An observational cohort study

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

Contact Info

Product

Resources

About