电话分诊中急性冠脉综合征的诊断：最初打电话的人有关系吗？一项横断面研究。

Diagnosing acute coronary syndrome in telephone triage: does it matter who initially calls? A cross-sectional study.

作者信息

Delissen Mathé, Dobbe Anique Sm, Erkelens Daphne Ca, Wouters Loes Tc, Ruijter Hester M den, Corsel Joy Sa, Sluiter Alja, Rutten Frans H, Zwart Dorien Lm

机构信息

Deptartment General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Str.6.131, Heidelberglaan 100, PO Box 85500, Utrecht, 3508 GA, Netherlands.

Laboratory of Experimental Cardiology, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands.

出版信息

BMC Prim Care. 2025 Apr 14;26(1):109. doi: 10.1186/s12875-025-02801-5.

DOI:10.1186/s12875-025-02801-5

PMID:40229694

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11995617/

Abstract

BACKGROUND

Adequate triage of patients with symptoms suggestive of ACS is crucial. Considering who calls might be useful to improve telephone triage of these patients. In this article, we aim to assess whether a call made by a surrogate is related to urgency allocation or higher odds of an acute coronary syndrome (ACS) than patient-initiated calls, and to assess possible gender differences.

METHODS

Cross-sectional study of patients with symptoms suggestive of ACS who called the out-of-hours service in primary care (OHS-PC). Calls were classified into "patient-initiated call" or "surrogate call". Call and patient characteristics were collected. Odds ratios (OR) were calculated for the relationship between the type of call and (i) urgency allocation, (ii) ACS, and (iii) ACS or other life-threatening event, stratified for gender.

RESULTS

In total 2,428 recordings were included for analysis. Around half of the recordings were surrogate calls, and these more often received a high urgency (80.0%) than patient-initiated calls (57.8%), OR 2.92 (95%CI 2.44-3.50); in women OR 3.46, (95%CI 2.70-4.45), in men OR 2.42 (95%CI 1.86-3.16). Of all participants, 11.0% were diagnosed with an ACS; in women 8.0%, in men 14.7%. In the surrogate call group this was 14.4%, in the patient-initiated call group 7.6%; OR 2.04 (95%CI 1.57-2.67). In women, the OR was 2.46 (95%CI 1.63-3.77), in men 1.69 (95%CI 1.20-2.41).

CONCLUSIONS

Compared to patients who call themselves, surrogate calls on behalf of a patient with symptoms suggestive of ACS receive more often a high urgency, and these patients have a risk twice as high of an ACS, an effect similar in women and men. It is useful for triage at the OHS-PC to consider who calls if it concerns a patient with symptoms suggestive of ACS.

CLINICAL TRIAL NUMBER

NTR7331. Registration Date 26-06-2018.

摘要

背景

对有急性冠状动脉综合征（ACS）症状的患者进行充分分诊至关重要。考虑来电者身份可能有助于改善对这些患者的电话分诊。在本文中，我们旨在评估代理人拨打的电话与紧急程度分配或急性冠状动脉综合征（ACS）发生几率高于患者主动拨打的电话之间是否存在关联，并评估可能的性别差异。

方法

对在基层医疗非工作时间服务（OHS - PC）中拨打热线、有ACS症状的患者进行横断面研究。电话分为“患者主动拨打”或“代理人拨打”。收集电话及患者特征。计算电话类型与以下方面关系的比值比（OR）：（i）紧急程度分配；（ii）ACS；（iii）ACS或其他危及生命事件，并按性别分层。

结果

共纳入2428条记录进行分析。约一半记录是代理人拨打的电话，这些电话比患者主动拨打的电话更常被分配为高紧急程度（80.0% 对57.8%），OR为2.92（95%CI 2.44 - 3.50）；女性中OR为3.46（95%CI 2.70 - 4.45），男性中OR为2.42（95%CI 1.86 - 3.16）。所有参与者中，11.0%被诊断为ACS；女性中为8.0%，男性中为14.7%。在代理人拨打组中这一比例为14.4%，在患者主动拨打组中为7.6%；OR为2.04（95%CI 1.57 - 2.67）。女性中OR为2.46（95%CI 1.63 - 3.77），男性中为1.69（95%CI 1.20 - 2.41）。