{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T05:19:10Z","timestamp":1791609550960,"version":"4.3.4"},"reference-count":33,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2020,8,20]],"date-time":"2020-08-20T00:00:00Z","timestamp":1597881600000},"content-version":"unspecified","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Grant from the department of general practice of the University Medical Center Utrecht"},{"name":"Personal promotion grant of D.L. Zwart, MD, PhD"},{"name":"Grant from the foundation \u2019The Netherlands Triage Standard\u2019"},{"name":"Grant from the foundation \u2018Stoffels-Hornstra\u2019"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2020,7,6]]},"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To assess the accuracy of semi-automatic assisted telephone triage in patients with acute chest discomfort against the diagnosis of acute coronary syndrome (ACS) or other life-threatening events (LTEs).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A cross-sectional study was performed of telephone conversations with 2023 patients with acute chest discomfort (pain, pressure, tightness or discomfort) who called out-of-hours services for primary care (OHS-PC) between 2014 and 2016. Sensitivity, specificity, positive and negative predicted values were calculated for a high urgency (patient seen within one\u2009hour) against the diagnoses of ACS and other LTEs. Diagnoses were retrieved from the patients' medical records in general practice, including hospital specialists' discharge letters.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 2023 patients who called because of chest discomfort, 227 (11.2%) had an ACS (men 14.9%, women 8.2%) and 58 (2.9%) had another LTE (men 3.6%, women 2.3%). The sensitivity and specificity of a high Netherlands Triage System (NTS) urgency allocation against ACS\/other LTEs were 0.73 (95% CI 0.68 to 0.78) and 0.43 (95% CI 0.40 to 0.45), respectively. In 13.2% of the calls the triage nurse overruled the NTS urgency, mostly by upscaling (11.0%). The sensitivity and specificity of the final urgency allocation were 0.86 (95% CI 0.81 to 0.90) and 0.34 (95% CI 0.32 to 0.37). The positive and negative predictive values of the final urgency were 0.18 (95% CI 0.17 to 0.19) and 0.94 (95% CI 0.92 to 0.95), respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The semi-automatic triage NTS tool underestimated the urgency in 27% of patients with ACS\/other LTEs. Overruling by triage nurses improved safety, but still 14% of men and women with ACS\/other LTEs received too low urgency, while efficiency remained poor.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>NTR7331.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2020-001376","type":"journal-article","created":{"date-parts":[[2020,9,22]],"date-time":"2020-09-22T00:00:21Z","timestamp":1600732821000},"page":"e001376","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Accuracy of telephone triage in primary care patients with chest discomfort: a cross-sectional study"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1525-9803","authenticated-orcid":false,"given":"Loes TCM","family":"Wouters","sequence":"first","affiliation":[{"name":"General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frans H","family":"Rutten","sequence":"additional","affiliation":[{"name":"General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daphne CA","family":"Erkelens","sequence":"additional","affiliation":[{"name":"General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"De Groot","sequence":"additional","affiliation":[{"name":"General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger AMJ","family":"Damoiseaux","sequence":"additional","affiliation":[{"name":"General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorien LM","family":"Zwart","sequence":"additional","affiliation":[{"name":"General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,9,21]]},"reference":[{"key":"2025081710581018000_7.2.e001376.1","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2296-15-51","article-title":"Management of chest pain: a prospective study from Norwegian out-of-hours primary care","volume":"15","author":"Burman","year":"2014","journal-title":"BMC Fam Pract"},{"key":"2025081710581018000_7.2.e001376.2","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2018-000859"},{"key":"2025081710581018000_7.2.e001376.3","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2016-206295"},{"key":"2025081710581018000_7.2.e001376.4","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmq097"},{"key":"2025081710581018000_7.2.e001376.5","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1080\/13814788.2016.1178718","article-title":"Reducing the use of out-of-hours primary care services: a survey among Dutch general practitioners","volume":"22","author":"Keizer","year":"2016","journal-title":"Eur J Gen Pract"},{"key":"2025081710581018000_7.2.e001376.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0170811","article-title":"Validity of the Manchester triage system in emergency care: a prospective observational study","volume":"12","author":"Zachariasse","year":"2017","journal-title":"PLoS One"},{"key":"2025081710581018000_7.2.e001376.7","doi-asserted-by":"publisher","DOI":"10.3109\/02813432.2011.629150"},{"key":"2025081710581018000_7.2.e001376.8","unstructured":"Healthcare Quality, Complaints and Disputes Act (WKKGZ), 2016"},{"key":"2025081710581018000_7.2.e001376.9","unstructured":"Rutten MH , Kant J , Giesen P . 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