Telephone triage of chest pain in out-of-hours primary care: external validation of a symptom-based prediction rule to rule out acute coronary syndromes

Author:

Manten Amy123ORCID,Harskamp Ralf E123ORCID,Busschers Wim B1,Moll van Charante Eric P1234,Himmelreich Jelle C L123

Affiliation:

1. Department of General Practice, Amsterdam UMC, University of Amsterdam, Academic Medical Center , Amsterdam 1105 AZ ,  The Netherlands

2. Amsterdam Public Health, Personalized Medicine , Amsterdam , The Netherlands

3. Amsterdam Cardiovascular Sciences , Amsterdam , The Netherlands

4. Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Academic Medical Center , Amsterdam 1105 AZ , The Netherlands

Abstract

Abstract Introduction Telephone triage is pivotal for evaluating the urgency of patient care, and in the Netherlands, the Netherlands Triage Standard (NTS) demonstrates moderate discrimination for chest pain. To address this, the Safety First Prediction Rule (SFPR) was developed to improve the safety of ruling out acute coronary syndrome (ACS) during telephone triage. Methods We conducted an external validation of the SFPR using data from the TRACE study, a retrospective cohort study in out-of-hours primary care. We evaluated the diagnostic accuracy assessment for ACS, major adverse cardiovascular events (MACE), and major events within 6 weeks. Moreover, we compared its performance with that of the NTS algorithm. Results Among 1404 included patients (57.3% female, 6.8% ACS, 8.6% MACE), the SFPR demonstrated good discrimination for ACS (C-statistic: 0.79; 95%-CI: 0.75–0.83) and MACE (C-statistic: 0.79; 95%-CI: 0.0.76–0.82). Calibration was satisfactory, with overestimation observed in high-risk patients for ACS. The SFPR (risk threshold 2.5%) trended toward higher sensitivity (95.8% vs. 86.3%) and negative predictive value (99.3% vs. 97.6%) with a lower negative likelihood ratio (0.10 vs. 0.34) than the NTS algorithm. Conclusion The SFPR proved robust for risk stratification in patients with acute chest pain seeking out-of-hours primary care in the Netherlands. Further prospective validation and implementation are warranted to refine and establish the rule’s clinical utility.

Funder

Amsterdam Cardiovascular Sciences Research Institute

ZonMw-HGOG

Publisher

Oxford University Press (OUP)

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