Pijn op de borst: huisarts of ambulance?: Een dilemma voor triagist en huisarts

Zeilstra, Roland; Giesen, Paul

doi:10.1007/s12445-017-0314-2

Cited by 6 publications

(3 citation statements)

References 17 publications

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“…This contrasts with our study of patients with SOB in which we did not find a difference between the sensitivity of the NTS and the 'final' urgency level, and only a marginal better specificity of the 'final' urgency. This difference is possibly caused by the fact that calamities at OHS-PC are most often caused by missing myocardial infarction and acute cardiac death, so triage of a patient with chest pain may be more stressful for triage nurses and therefore they are possibly more likely to overrule the NTS system [10,29]. For neurological deficit, triage nurses presumably know that the prevalence of a serious condition is higher so here too they may overrule to a higher urgency more often [11].…”

Section: Comparison To Literaturementioning

confidence: 99%

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

Spek,

Venekamp,

de Groot

et al. 2024

BMC Prim. Care

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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.

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Section: Comparison To Literaturementioning

confidence: 99%

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

Spek,

Venekamp,

de Groot

et al. 2024

BMC Prim. Care

View full text Add to dashboard Cite

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“…In Dutch primary care, triage is initially through telephone consultation using standardised Netherlands Triage Standard (NTS) protocols [ 2 , 3 ]. The NTS chest pain protocol was developed based on a consensus of expert opinion and not validated prior to its implementation [ 4 ]. A recent regional evaluation revealed that the NTS performs modestly, with a false-positive rate of 83%, and underestimated urgencies in 27% of patients with an ACS or another life-threatening event [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…A recent regional evaluation revealed that the NTS performs modestly, with a false-positive rate of 83%, and underestimated urgencies in 27% of patients with an ACS or another life-threatening event [ 5 ]. Moreover, it was shown that the current triage process leads to many unnecessary referrals, causing an increased workload, overburdening of ambulance services and overcrowding of emergency departments [ 4 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Marburg Heart Score and INTERCHEST score compared to current telephone triage for chest pain in out-of-hours primary care

et al. 2022

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Introduction Chest pain is a common and challenging symptom for telephone triage in urgent primary care. Existing chest-pain-specific risk scores originally developed for diagnostic purposes may outperform current telephone triage protocols. Methods This study involved a retrospective, observational cohort of consecutive patients evaluated for chest pain at a large-scale out-of-hours primary care facility in the Netherlands. We evaluated the performance of the Marburg Heart Score (MHS) and INTERCHEST score as stand-alone triage tools and compared them with the current decision support tool, the Netherlands Triage Standard (NTS). The outcomes of interest were: C‑statistics, calibration and diagnostic accuracy for optimised thresholds with major events as the reference standard. Major events are a composite of all-cause mortality and both cardiovascular and non-cardiovascular urgent underlying conditions occurring within 6 weeks of initial contact. Results We included 1433 patients, 57.6% women, with a median age of 55.0 years. Major events occurred in 16.4% (n = 235), of which acute coronary syndrome accounted for 6.8% (n = 98). For predicting major events, C‑statistics for the MHS and INTERCHEST score were 0.74 (95% confidence interval: 0.70–0.77) and 0.76 (0.73–0.80), respectively. In comparison, the NTS had a C-statistic of 0.66 (0.62–0.69). All had appropriate calibration. Both scores (at threshold ≥ 2) reduced the number of referrals (with lower false-positive rates) and maintained equal safety compared with the NTS. Conclusion Diagnostic risk stratification scores for chest pain may also improve telephone triage for major events in out-of-hours primary care, by reducing the number of unnecessary referrals without compromising triage safety. Further validation is warranted.

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