The relation between face drooping and the urgency allocation and the diagnosis of stroke or TIA at out-of-hours services of primary care

Abstract

Background: Timely diagnosis of a stroke or transient ischemic attack (TIA) is important to improve a patient’s clinical outcome. In the Netherlands, about all out-of-hours primary care services (OHS-PCs) use the “Netherlands Triage Standard” (NTS) as a semi-automatic digital support tool for telephone triage. Face drooping may be difficult to recognise and can have several underlying conditions. Aim: To assess the relation between face drooping and (i) the urgency allocation, and (ii) the diagnosis of stroke or TIA in patients with neurological deficit symptoms who called the OHS-PC. Method: In the SAFETY-FIRST study, data of patients suspected of stroke or TIA were collected retrospectively at nine OHS-PCs in the vicinity of Utrecht, the Netherlands. The association between face drooping and (i) the urgency allocation and (ii) the final diagnosis was calculated with crude and adjusted odds ratios (OR) using logistic regression analysis. Results: 1377 patients could be analysed. The mean age was 68.9 (SD 18.4) years, 56.4% were women and 27% had face drooping. In total, 69.6% were allocated as high urgency (80.2% in those with face drooping and 65.6% in those without), and 52.8% were diagnosed with a stroke or TIA (51.3% in those with face drooping and 53.4% in those without). Patients with face drooping had a 2.60 (95%CI 1.92-3.52) times higher odds of a high urgency allocation than those without face drooping. There was no significant correlation between face drooping and the diagnosis of stroke or TIA (adjusted OR was 1.16 (95%CI 0.88-1.53). Conclusion: In patients suspected of a stroke or TIA, who called the OHS-PC, face drooping resulted in a higher urgency allocation, but the relation with a stroke or TIA was similar compared to that of patients without face drooping.