{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:38:04Z","timestamp":1772804284942,"version":"3.50.1"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2024,9,20]],"date-time":"2024-09-20T00:00:00Z","timestamp":1726790400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["10060012210005"],"award-info":[{"award-number":["10060012210005"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>In patients suspected of stroke or transient ischemic attack (TIA), rapid triaging is imperative to improve clinical outcomes. For this purpose, balance-eye-face-arm-speech-time (BEFAST) items are used in out-of-hours primary care (OHS-PC). We explored the risk of stroke and TIA among BEFAST positive patients calling to the OHS-PC, and assessed whether additional predictors could improve risk stratification.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This is a cross-sectional study of retrospectively gathered routine care data from telephone triage tape-recordings of patients calling the OHS-PC with neurological deficit symptoms, classified as BEFAST positive. Four models\u2013with the predictors age, sex, a history of cardiovascular or cerebrovascular disease, and cardiovascular risk factors\u2013were fitted using logistic regression to predict the outcome stroke or TIA. Likelihood ratio testing was used to select the best model, which was subsequently internally validated.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The risk of stroke or TIA diagnosis was 52% among 1,289 BEFAST positive patients, median age 72 years, 56% female sex. Of patients with the outcome stroke\/TIA, 24% received a low urgency allocation, while 92% had signs or symptoms when calling. Only the addition of age and sex improved predicting stroke or TIA (internally validated c-statistic 0.72, 95%CI 0.69\u20130.75). The predicted risk of stroke or TIA remained below 20% in those aged below 40. Females aged 70 or over and males aged 55 or over, had a predicted risk above 50%.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>Urgency allocation appears to be suboptimal in BEFAST positive patients calling the OHS-PC. Risk stratification could be improved in this setting by adding age and sex.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0310769","type":"journal-article","created":{"date-parts":[[2024,9,20]],"date-time":"2024-09-20T17:26:52Z","timestamp":1726853212000},"page":"e0310769","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Additional predictors of stroke and transient ischaemic attack in BEFAST positive patients in out-of-hours emergency primary care"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6785-214X","authenticated-orcid":true,"given":"Florien S.","family":"van Royen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geert-Jan","family":"Geersing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daphne C.","family":"Erkelens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7582-2343","authenticated-orcid":true,"given":"Math\u00e9","family":"Delissen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorn V. 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Vol. 93, Journal of Clinical Neuroscience","author":"M Pohl","year":"2021","journal-title":"Churchill Livingstone;"},{"key":"pone.0310769.ref004","doi-asserted-by":"crossref","DOI":"10.7326\/0003-4819-155-2-201107190-00006","article-title":"Quality of After-Hours Primary Care in the Netherlands: A Narrative Review","author":"P Giesen","year":"2011"},{"key":"pone.0310769.ref005","unstructured":"Netherlands Triage Standard, https:\/\/de-nts.nl\/, accessed July 31 2023."},{"issue":"1","key":"pone.0310769.ref006","doi-asserted-by":"crossref","DOI":"10.1186\/s12875-020-01334-3","article-title":"Accuracy of telephone triage in patients suspected of transient ischaemic attack or stroke: a cross-sectional study.","volume":"21","author":"DC Erkelens","year":"2020","journal-title":"BMC Fam Pract"},{"issue":"1","key":"pone.0310769.ref007","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1161\/01.STR.0000044170.46643.5E","article-title":"Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test","volume":"34","author":"J Harbison","year":"2003","journal-title":"Stroke"},{"issue":"2","key":"pone.0310769.ref008","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1161\/STROKEAHA.116.015169","article-title":"BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): Reducing the Proportion of Strokes Missed Using the FAST Mnemonic.","volume":"48","author":"S Aroor","year":"2017","journal-title":"Stroke"},{"key":"pone.0310769.ref009","article-title":"Prehospital stroke scales as screening tools for early identification of stroke and transient ischemic attack","author":"Z Zhelev","year":"2019","journal-title":"Cochrane Database of Systematic Reviews"},{"issue":"7","key":"pone.0310769.ref010","article-title":"Optimisation of telephone triage of callers with symptoms suggestive of acute cardiovascular disease in out-of-hours primary care: Observational design of the Safety First study","volume":"9","author":"DCA Erkelens","year":"2019","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0310769.ref011","doi-asserted-by":"crossref","first-page":"W1","DOI":"10.7326\/M14-0698","article-title":"Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): Explanation and elaboration.","volume":"162","author":"KGM Moons","year":"2015","journal-title":"Ann Intern Med"},{"key":"pone.0310769.ref012","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-19425-7","volume-title":"Regression modeling strategies: with applications to linear models, logistic and ordinal regression, and survival analysis.","author":"FE Harrell","year":"2015"},{"issue":"3","key":"pone.0310769.ref013","article-title":"mice: Multivariate Imputation by Chained Equations in R.","volume":"45","author":"Buuren S van","year":"2011","journal-title":"J Stat Softw."},{"key":"pone.0310769.ref014","unstructured":"Team RC. 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