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

Publication date: Mar 27, 2024

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. 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. 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 

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Concepts Keywords
August Adult
Expert After-Hours Care
Nurses Cross-Sectional Studies
Pneumonia Dyspnea
U2 Female
Heart Failure
Middle Aged
Netherlands triage standard
Out-of-hours primary care
Primary Health Care
Shortness of breath
Telephone triage


Type Source Name
disease MESH acute coronary syndrome
disease MESH pulmonary embolism
disease MESH heart failure
disease MESH pneumonia
disease MESH COVID-19
disease MESH infection
disease MESH COPD
pathway REACTOME Reproduction
disease VO efficiency
drug DRUGBANK Trestolone
disease IDO process
disease MESH emergency
disease VO organization
disease IDO symptom
disease MESH embolism
disease MESH transient ischemic attack
disease MESH stroke
disease MESH sepsis
disease MESH pneumothorax
disease MESH subcutaneous emphysema
disease MESH bleeding
disease MESH Takotsubo cardiomyopathy
disease MESH diverticulitis
disease MESH respiratory insufficiency
disease MESH asthma
pathway KEGG Asthma
drug DRUGBANK Oxygen
disease IDO history
disease VO population
disease MESH sweating
disease MESH pallor
disease MESH Chest pain
disease IDO blood
disease MESH Musculoskeletal pain
disease MESH Posture
drug DRUGBANK Tropicamide
drug DRUGBANK Polyethylene glycol
disease MESH atrial fibrillation
disease MESH atrial flutter
disease MESH gastro oesophageal reflux
disease MESH bronchitis
disease MESH bronchial hyperreactivity
disease MESH hay fever
disease MESH Anaphylaxis
disease MESH Upper respiratory tract infection
disease MESH Hyperventilation
drug DRUGBANK Indoleacetic acid
disease MESH death
disease VO inefficient
disease MESH myocardial infarction
disease VO effective
drug DRUGBANK Icodextrin
disease VO protocol
drug DRUGBANK Methyl isocyanate
disease IDO quality
disease VO frequency
disease VO publication
disease MESH adverse cardiac event
disease VO age

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