{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T03:02:26Z","timestamp":1780455746302,"version":"3.54.1"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>The Dutch Triage Standard (NTS) supports nurses in assessing case urgency in out-of-hours general practice (GP) care; however, its suitability for fever-related pediatric cases remains debated. This study examines the agreement between pre-consultation NTS urgency classifications (U-scores) and post-consultation management decisions in febrile children, and whether the NTS reduces between-center variation in decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a secondary analysis of the CHILI study, including 22 089 consultations for children under 12 with fever, across 18 out-of-hours GP centers (2015- 2016). Adjusted logistic regression models, with natural cubic splines and random intercepts, explored the associations between U-scores and three outcomes: referral to secondary care, antibiotic prescription, and other medication use. Intraclass correlation coefficients assessed between-center variability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Unadjusted and adjusted percentages of the three outcomes showed similar trends. 24.5% of consultations were classified at low urgency levels (U4-5) before the consultation. Adjusted referral probabilities decreased with lower urgency: 29% (U1) to 0.8% (U5). Strikingly, antibiotic prescription rates were highest for U3 (26.2%) and U4 (25.1%). The probability of other medication prescriptions decreased steadily across urgency levels. ICCs revealed low between-center variability, which did not decrease after accounting for U-scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher NTS urgency classifications are associated with increased referral rates during fever-related out-of-hours GP consultations. However, overall referral rates remain low, while a substantial number of consultations are pre-classified by the NTS as low urgency, contributing to a high workload of unnecessary consultations that highlights the need for more efficient triage and resource allocation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/fampra\/cmag015","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T12:46:45Z","timestamp":1774010805000},"source":"Crossref","is-referenced-by-count":0,"title":["Performance of the Dutch Triage standard in managing fever in children in out-of-hours primary care: a secondary analysis of the chili study"],"prefix":"10.1093","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3946-2451","authenticated-orcid":false,"given":"Robin N","family":"Gottwald","sequence":"first","affiliation":[{"name":"Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University , Maastricht 6229 HA ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2700-4752","authenticated-orcid":false,"given":"Eefje G P M","family":"de Bont","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University , Maastricht 6229 HA ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9550-5674","authenticated-orcid":false,"given":"Jochen W L","family":"Cals","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University , Maastricht 6229 HA ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3037-122X","authenticated-orcid":false,"given":"Laure","family":"Wynants","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University , Maastricht 6229 HA ,","place":["The Netherlands"]},{"name":"Department of Development and Regeneration, KU Leuven , Leuven 3000 ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"2026060222014062400_cmag015-B1","doi-asserted-by":"publisher","first-page":"e007365","DOI":"10.1136\/bmjopen-2014-007365","article-title":"Workload and management of childhood fever at general practice out-of-hours care: an observational cohort study","volume":"5","author":"de Bont","year":"2015","journal-title":"BMJ 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