| dc.description.abstract | ABSTRACT
Background: Telephone triage in family medicine clinics faces challenges in assessing the urgency of patients suspected of acute cardiovascular diseases, e.g. ACS (Acute coronary syndrome). Early diagnosis is crucial, but telephone assessment of symptoms is difficult, even with the help of a semi-automatic decision tool such as the Netherlands Triage Standard (NTS) used by triage nurses use at the out-of-hours primary care service (OHS-PC). This study aim was to assess whether interscapular pain is a diagnostic factor for ACS in male and female who contact the OHS-PC for chest discomfort.
Methods: A cross-sectional study evaluating telephone triage recordings of patients with chest discomfort from nine out-of-hours primary care centers in the Netherlands. We could analyze 1,982 real-life recordings from 2014-2016. The final diagnosis was obtained from the patient's own GP.
Results: Of the 1,982 patients with chest discomfort the mean age was 58.3 (SD 19.5) years, 45% were males, and 379 (19%) had interscapular pain. In total, 1,246 (63%) patients received a high-urgency allocation. The crude OR for high-urgency allocation for patients with interscapular pain compared to those without, was 0.86 (95%CI 0.67-1.10); for males 0.78 (95%CI 0.53-1.17), for females 0.91 (95%CI 0.67-1.25). These relationships remained similar after correction for age. In total, 234 (12%) patients were diagnosed with ACS, and the crude OR for ACS for patients with interscapular pain compared to patients without interscapular pain was 1.30 (95%CI 0.89-1.88); for males 1.12 (95%CI 0.72-1.74), for females 1.29 (95%CI 0.78-2.13). After correction for age, the adjusted OR for males was 1.05 (95%CI 0.62-1.76), and for females 1.12 (95%CI 0.68-2.07).
Conclusion: In males and females with chest discomfort presence of interscapular pain did not affect urgency allocation and it was not useful for predicting ACS. | |
