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.
BMC Fam Pract. 2020 Dec 5;21(1):256. doi: 10.1186/s12875-020-01334-3.
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.
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.
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).
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.
The Netherlands National Trial Register, identification number NTR7331 /Trial NL7134 .
荷兰分诊标准（NTS）是荷兰非工作时间初级保健服务（OHS-PC）电话分诊中广泛使用的决策支持工具，但从未针对临床结果进行过验证。我们的目的是确定 NTS 紧急程度分配对提示短暂性脑缺血发作（TIA）或中风的神经症状患者的准确性，以 TIA、中风和其他（神经）危及生命的事件（LTEs）作为参考。
这是一项横断面研究，对 2014 年至 2016 年间致电 OHS-PC 的具有神经症状的患者的电话分诊记录进行研究。分配的 NTS 紧急程度来自 OHS-PC 的电子病历。临床结果从患者自己的全科医生的电子病历中检索。根据 TIA/中风/其他 LTE 作为参考，计算高 NTS 紧急程度分配（3 小时内获得医疗帮助）的准确性，包括灵敏度、特异性、阳性和阴性预测值（PPV 和 NPV）。
在 1269 名患者中，635 名（50.0%）被诊断为 TIA/中风（34.2% TIA/轻度中风，15.8% 为大缺血性或出血性中风），4.8%为其他 LTE。对于 TIA/中风/其他 LTE，NTS 紧急程度分配的灵敏度和特异性分别为 0.72（95%CI 0.68-0.75）和 0.48（95%CI 0.43-0.52），PPV 和 NPV 分别为 0.62（95%CI 0.60-0.64）和 0.58（95%CI 0.54-0.62）。
在为 TIA/中风/其他 LTE 患者分配适当的紧急程度方面，荷兰 OHS-PC 中使用的 NTS 决策支持工具在安全性（灵敏度）和效率（特异性）方面表现不佳。
荷兰国家试验注册处，注册号 NTR7331/Trial NL7134。
