短气患者拨打非工作时间初级保健时的紧急情况分配准确性：一项横断面研究。
Accuracy of urgency allocation in patients with shortness of breath calling out-of-hours primary care: a cross-sectional study.
机构信息
Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht Utrecht University, Utrecht, The Netherlands.
Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht Utrecht University, Utrecht, The Netherlands.
出版信息
BMC Prim Care. 2024 Mar 27;25(1):101. doi: 10.1186/s12875-024-02347-y.
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 .
背景
在非工作时间的初级保健（OHS-PC）中，电话分诊期间经常使用半自动决策支持工具。在荷兰，使用的是荷兰分诊标准（NTS）。NTS 主要基于专家意见，缺乏关于 NTS 紧急分配对因呼吸急促（SOB）呼叫患者的临床相关结局的诊断准确性的证据。
方法
我们纳入了 2020 年 9 月 1 日至 2021 年 8 月 31 日期间，两名荷兰大型 OHS-PC 中心因 SOB 联系的成年人（≥18 岁）的数据，并且可以从他们自己的全科医生（GP）处检索到关于最终诊断的随访数据。使用危及生命的事件（LTEs）作为参考，确定 NTS 紧急程度（高（U1/U2）与低（U3/U4/U5）和“最终”紧急程度（包括分诊护士或监督全科医生（GP）对紧急程度的推翻）的诊断准确性（敏感性和特异性及其相应的 95%置信区间（CI））。LTEs 包括急性冠状动脉综合征、肺栓塞、急性心力衰竭和严重肺炎等。
结果
在 2012 名符合条件的分诊电话中，我们纳入了 1833 名因 SOB 呼叫 OHS-PC 的成年人，平均年龄为 53.3（21.5）岁，55.5%为女性，16.6%显示有 LTE。最常见的是严重 COVID-19 感染（6.0%）、急性心力衰竭（2.6%）、严重 COPD 加重（2.1%）或严重肺炎（1.9%）。NTS 紧急程度的敏感性为 0.56（95%CI 0.50-0.61），特异性为 0.61（95%CI 0.58-0.63）。分诊护士和/或监督全科医生推翻 NTS 紧急程度分配对敏感性没有影响（0.56 与 0.54，p=0.458），但特异性略有提高（0.61 与 0.65，p<0.001）。
结论
在荷兰 OHS-PC 因 SOB 呼叫的成年人中，半自动决策支持工具 NTS 在紧急程度的安全性（敏感性）和效率（特异性）方面表现不佳。在因 SOB 呼叫 OHS-PC 的患者中，电话分诊仍有改进的空间。
试验注册
荷兰试验注册处，编号：NL9682。
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