دورية أكاديمية
أعرض في EDS

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

التفاصيل البيبلوغرافية
العنوان: Accuracy of urgency allocation in patients with shortness of breath calling out-of-hours primary care: a cross-sectional study.
المؤلفون: Spek M; Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht Utrecht University, Utrecht, The Netherlands. m.spek-3@umcutrecht.nl., Venekamp RP; Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht Utrecht University, Utrecht, The Netherlands., de Groot E; Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht Utrecht University, Utrecht, The Netherlands., Geersing GJ; Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht Utrecht University, Utrecht, The Netherlands., Erkelens DCA; Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht Utrecht University, Utrecht, The Netherlands., van Smeden M; Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht Utrecht University, Utrecht, The Netherlands., Dobbe ASM; Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht Utrecht University, Utrecht, The Netherlands., Delissen M; Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht Utrecht University, Utrecht, The Netherlands., Rutten FH; Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht Utrecht University, Utrecht, The Netherlands., Zwart DL; Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht Utrecht University, Utrecht, The Netherlands.
المصدر: BMC primary care [BMC Prim Care] 2024 Mar 27; Vol. 25 (1), pp. 101. Date of Electronic Publication: 2024 Mar 27.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: BioMed Central Ltd Country of Publication: England NLM ID: 9918300889006676 Publication Model: Electronic Cited Medium: Internet ISSN: 2731-4553 (Electronic) Linking ISSN: 27314553 NLM ISO Abbreviation: BMC Prim Care Subsets: MEDLINE
أسماء مطبوعة: Original Publication: [London] : BioMed Central Ltd., [2022]-
مواضيع طبية MeSH: Heart Failure* , After-Hours Care*/methods , Pneumonia*, Adult ; Humans ; Female ; Middle Aged ; Male ; Cross-Sectional Studies ; Dyspnea/diagnosis ; Primary Health Care/methods
مستخلص: 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 .
(© 2024. The Author(s).)
References: Fam Pract. 2011 Jun;28(3):334-41. (PMID: 21106645)
Ann Intern Med. 2017 May 16;166(10):737-742. (PMID: 28418455)
J Evid Based Med. 2017 May;10(2):129-135. (PMID: 27792290)
J Gen Intern Med. 1998 Sep;13(9):579-85. (PMID: 9754512)
Eur J Cardiovasc Nurs. 2018 Oct;17(7):660-666. (PMID: 29749756)
BMC Health Serv Res. 2017 Aug 30;17(1):614. (PMID: 28854916)
Fam Pract. 2018 Jul 23;35(4):440-445. (PMID: 29272417)
Open Heart. 2020 Aug;7(2):. (PMID: 32958556)
J Emerg Nurs. 2015 Sep;41(5):396-403. (PMID: 25814095)
J Gen Fam Med. 2020 Oct 26;22(2):109-110. (PMID: 33717790)
Int Emerg Nurs. 2015 Apr;23(2):47-52. (PMID: 25087059)
Indian J Med Res. 2023 Oct 1;158(4):330-333. (PMID: 37929357)
BMC Fam Pract. 2020 Dec 5;21(1):256. (PMID: 33278874)
JAMA. 2014 Mar 19;311(11):1117-24. (PMID: 24643601)
J Clin Med. 2020 Jun 02;9(6):. (PMID: 32498230)
Dtsch Arztebl Int. 2013 Aug;110(33-34):563-71; quiz 572. (PMID: 24069091)
BMJ Open. 2022 Apr 21;12(4):e059549. (PMID: 35450911)
Br J Gen Pract. 2019 Aug 29;69(686):e595-e604. (PMID: 31262846)
Pediatrics. 1979 Nov;64(5):553-7. (PMID: 492827)
J Adv Nurs. 2012 Dec;68(12):2610-21. (PMID: 22676805)
Acad Emerg Med. 2018 Nov;25(11):1227-1234. (PMID: 29738108)
Int Emerg Nurs. 2020 Nov;53:100931. (PMID: 33035878)
Acad Emerg Med. 2017 Sep;24(9):1137-1149. (PMID: 28493626)
BMC Emerg Med. 2019 Jan 7;19(1):3. (PMID: 30612552)
J Emerg Med. 2016 Apr;50(4):678-89. (PMID: 26458788)
Br J Gen Pract. 2010 May;60(574):e201-12. (PMID: 20423575)
Postgrad Med. 2021 Aug;133(sup1):36-41. (PMID: 33910469)
Fam Pract. 2020 Nov 28;37(6):744-750. (PMID: 32597962)
Circulation. 2020 May 19;141(20):1648-1655. (PMID: 32200663)
Emerg Med J. 2017 Nov;34(11):703-710. (PMID: 28751363)
Eur J Gen Pract. 2016 Dec;22(4):240-246. (PMID: 27652899)
J Gen Intern Med. 2008 May;23(5):517-22. (PMID: 18228110)
Int J Cardiol. 2013 Jul 1;166(3):752-4. (PMID: 23084108)
Circulation. 2020 Jul 14;142(2):184-186. (PMID: 32330083)
فهرسة مساهمة: Keywords: Netherlands triage standard; Out-of-hours primary care; Shortness of breath; Telephone triage
تواريخ الأحداث: Date Created: 20240328 Date Completed: 20240329 Latest Revision: 20240329
رمز التحديث: 20240329
مُعرف محوري في PubMed: PMC10967202
DOI: 10.1186/s12875-024-02347-y
PMID: 38539092
قاعدة البيانات: MEDLINE
الوصف
تدمد:2731-4553
DOI:10.1186/s12875-024-02347-y