Accuracy of telephone triage in patients suspected of transient ischaemic attack or stroke: a cross-sectional study
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RESEARCH ARTICLE
Open Access
Accuracy of telephone triage in patients suspected of transient ischaemic attack or stroke: a cross-sectional study Daphne C. Erkelens* , Frans H. Rutten, Loes T. Wouters, L. Servaas Dolmans, Esther de Groot, Roger A. Damoiseaux and Dorien L. Zwart
Abstract Background: The Netherlands Triage Standard (NTS) is a widely used decision support tool for telephone triage at Dutch out-of-hours primary care services (OHS-PC), which, however, has never been validated against clinical outcomes. We aimed to determine the accuracy of the NTS urgency allocation for patients with neurological symptoms suggestive of a transient ischaemic attack (TIA) or stroke, with the clinical outcomes TIA, stroke, and other (neurologic) life-threatening events (LTEs) as the reference. Method: A cross-sectional study of telephone triage recordings of patients with neurological symptoms calling the OHS-PC between 2014 and 2016.The allocated NTS urgencies were derived from the electronic medical records of the OHS-PC. The clinical outcomes were retrieved from the electronic medical records of the patients’ own general practitioners. The accuracy of a high NTS urgency allocation (medical help within 3 h) was calculated in terms of sensitivity, specificity, positive and negative predictive values (PPV and NPV) with the clinical outcomes TIA/stroke/other LTEs as the reference. Results: Of 1269 patients, 635 (50.0%) received the diagnosis TIA/stroke (34.2% TIA/minor stroke, 15.8% major ischaemic or haemorrhagic stroke), and 4.8% other LTEs. For TIA/stroke/other LTEs, the sensitivity and specificity of the NTS urgency allocation were 0.72 (95%CI 0.68–0.75) and 0.48 (95%CI 0.43–0.52), and the PPV and NPV were 0.62 (95%CI 0.60–0.64) and 0.58 (95%CI 0.54–0.62). Conclusions: The NTS decision support tool used in Dutch OHS-PC performed poor to moderately regarding safety (sensitivity) and efficiency (specificity) in allocating adequate urgencies to patients with and without TIA/stroke/other LTEs. Trial registration: The Netherlands National Trial Register, identification number NTR7331 /Trial NL7134.
Background Prompt recognition of patients with a transient ischaemic attack (TIA) or stroke is crucial for timely initiation of therapeutic interventions to minimise the risk of (permanent) brain injury and recurrent stroke [1–6]. Previous studies showed that urgent diagnostic assessment of TIA and minor stroke patients followed by a timely start * Correspondence: [email protected] Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, STR 6.131, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
of stroke preventive treatment resulted in a tremendous decrease of the early stroke risk [1, 5, 7] with a reduction of recurrent stroke up to 80% within 3 months [1]. However, the detection of TIA, and to a lesser extent stroke, may be challenging because multiple other diseases like migraine with aura, seizures or syncope can mimic TIA or
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