Are there gender disparities in symptom presentation or triage of patients with chest discomfort at primary care out-of-hours services? An observational study

Meer, Manon G van der; Appelman, Yolande; Rutten, Karlijn; Graaf, Yolanda van der; Nathoe, Hendrik M.; Doevendans, Pieter A.; Smit, Michelle; Verheij, Emmy; Botermans, Anne; Rutten, Frans H.

doi:10.1136/bmjopen-2019-031613

Cited by 12 publications

(11 citation statements)

References 23 publications

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“…In previous studies on gender differences in OHS-PS call duration, an opposite finding was presented for ACS. The mean call duration was longer in women with no ACS compared to women with ACS, whereas there was no difference in duration for men (22). Our finding is therefore not general for one gender but seems dependent on the clinical diagnosis that is suspected.…”

Section: Discussioncontrasting

confidence: 64%

“…This is in line with previous findings for acute coronary syndrome (ACS). Discriminating patients with and without ACS in case of complaints of chest discomfort is equally difficult for men and women who contacted OHS-PC ( 22 ). Both genders with chest discomfort received high-urgency allocation in ~65% and in women with ACS in 96%, and in men in 88% ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

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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

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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.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

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

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“…13 In a recent Dutch OHS-PC study among 23 women and 34 men with ACS, and 253 women and 208 men without ACS, symptoms associated with ACS in women and men seemed quite similar and the authors conclude that discriminating ACS in patients with chest discomfort who contacted primary care OHS is difficult in both women and men. 17 We aimed to identify clinical variables that are associated with the diagnosis ACS in women and men with chest discomfort who contact out-of-hours primary care (OHS-PC) by telephone, and to explore whether there are indications these variables differ among women and men. For analyses, we used the very initial symptom presentation as available from the recorded telephone triage conversations.…”

Section: Introductionmentioning

confidence: 99%

Gender-stratified analyses of symptoms associated with acute coronary syndrome in telephone triage: a cross-sectional study

et al. 2021

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ObjectivesTo identify clinical variables that are associated with the diagnosis acute coronary syndrome (ACS) in women and men with chest discomfort who contact out-of-hours primary care (OHS-PC) by telephone, and to explore whether there are indications whether these variables differ among women and men.DesignCross-sectional study in which we compared patient and call characteristics of triage call recordings between women with and without ACS, and men with and without ACS.SettingNine OHS-PC in the Netherlands.Participants993 women and 802 men who called OHS-PC for acute chest discomfort (pain, pressure, tightness or discomfort) between 2014 and 2016.Primary outcome measureDiagnosis of ACS retrieved from the patient’s medical record in general practice, including hospital specialists’ discharge letters.ResultsAmong 1795 patients (mean age 58.8 (SD 19.5) years, 55.3% women), 15.0% of men and 8.6% of women had an ACS. In both sexes, retrosternal chest pain was associated with ACS (women with ACS vs without 62.3% vs 40.3%, p=0.002; men with ACS vs without 52.5% vs 39.7%, p=0.032; gender interaction, p=0.323), as was pressing/heavy/tightening pain (women 78.6% vs 61.5%, p=0.011; men 82.1% vs 57.4%, p=<0.001; gender interaction, p=0.368) and radiation to the arm (women 75.6% vs 45.9%, p<0.001; men 56.0% vs 34.8%, p<0.001; gender interaction, p=0.339). Results indicate that only in women were severe pain (65.4% vs 38.1%, p=0.006; gender interaction p=0.007) and radiation to jaw (50.0% vs 22.9%, p=0.007; gender interaction p=0.015) associated with ACS.Ambulances were dispatched equally in women (72.9%) and men with ACS (70.0%).ConclusionOur results indicate there were more similarities than differences in symptoms associated with the diagnosis ACS for women and men. Important exceptions were pain severity and radiation of pain in women. Whether these differences have an impact on predicting ACS needs to be further investigated with multivariable analyses.Trial registration numberNTR7331.

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“… 1 Our results may also be generalizable to EMS settings, because the chance of having an ACS among those calling for chest discomfort is similar in the EMS setting and the OHS-PC setting. 13 22 …”

Section: Discussionmentioning

confidence: 99%

“…It is the most common reason for allocating an ambulance within 15 min (U1) to patients calling OHS-PC (60.7% of all dispatches), but only around 10% actually have an ACS . [11][12][13] The aim of our study was to assess the accuracy of telephone triage for patients with chest discomfort who call the OHS-PC with the clinical outcome ACS/other LTE as the reference. Both the accuracy of the NTS tool and the 'final' urgency, including overruling by the triage nurses, were evaluated.…”

Section: Key Questionsmentioning

confidence: 99%

Accuracy of telephone triage in primary care patients with chest discomfort: a cross-sectional study

Wouters¹,

Rutten²,

Erkelens³

et al. 2020

Open Heart

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ObjectiveTo assess the accuracy of semi-automatic assisted telephone triage in patients with acute chest discomfort against the diagnosis of acute coronary syndrome (ACS) or other life-threatening events (LTEs).MethodsA cross-sectional study was performed of telephone conversations with 2023 patients with acute chest discomfort (pain, pressure, tightness or discomfort) who called out-of-hours services for primary care (OHS-PC) between 2014 and 2016. Sensitivity, specificity, positive and negative predicted values were calculated for a high urgency (patient seen within one hour) against the diagnoses of ACS and other LTEs. Diagnoses were retrieved from the patients' medical records in general practice, including hospital specialists' discharge letters.ResultsOf 2023 patients who called because of chest discomfort, 227 (11.2%) had an ACS (men 14.9%, women 8.2%) and 58 (2.9%) had another LTE (men 3.6%, women 2.3%). The sensitivity and specificity of a high Netherlands Triage System (NTS) urgency allocation against ACS/other LTEs were 0.73 (95% CI 0.68 to 0.78) and 0.43 (95% CI 0.40 to 0.45), respectively. In 13.2% of the calls the triage nurse overruled the NTS urgency, mostly by upscaling (11.0%). The sensitivity and specificity of the final urgency allocation were 0.86 (95% CI 0.81 to 0.90) and 0.34 (95% CI 0.32 to 0.37). The positive and negative predictive values of the final urgency were 0.18 (95% CI 0.17 to 0.19) and 0.94 (95% CI 0.92 to 0.95), respectively.ConclusionsThe semi-automatic triage NTS tool underestimated the urgency in 27% of patients with ACS/other LTEs. Overruling by triage nurses improved safety, but still 14% of men and women with ACS/other LTEs received too low urgency, while efficiency remained poor.Trial registration numberNTR7331.

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Are there gender disparities in symptom presentation or triage of patients with chest discomfort at primary care out-of-hours services? An observational study

Cited by 12 publications

References 23 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

Gender-stratified analyses of symptoms associated with acute coronary syndrome in telephone triage: a cross-sectional study

Accuracy of telephone triage in primary care patients with chest discomfort: a cross-sectional study

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