Adequacy of telephone triage using the Netherlands Triage Standard in primary care patients with sepsis: a retrospective study

Abstract

Background: The key factor to improve outcomes of patients with sepsis is early initiation of adequate treatment. The Netherlands Triage Standard (NTS) is a decision support tool for telephone triage used at the Dutch out-of-hours general practitioner (OOH GP) cooperatives, which has never been validated against the clinical outcome sepsis. Aim: To determine the adequacy of the NTS urgency allocation for patients with sepsis. Method: A retrospective study using routine registration data from 2017-2019. Data were retrieved from the electronical medical records of the OOH GP cooperatives and were linked to the medical records of the patients’ own GP, hospital records and deaths registration. The primary outcome was adverse sepsis related outcome (ASRO), defined as (1) intensive careunit admission <7 days, or (2) death due to infection <30 days. For each entrance complaint, the odds ratio for the outcome ASRO was calculated. The allocated urgency was dichotomised into high-urgent (U1-U2) and low-urgent (U3-U5) and the proportion of highurgent cases was calculated for each entrance complaint. Results: 287.385 contacts were included of which 1721 had the outcome ASRO. Of all contacts with outcome ASRO, 58% were triaged as high-urgent. Complaints of arm or leg (26%), urinary problems (30%), diarrhoea (33%), cough (38%) and strange or suicidal behaviour (44%), general malaise (52%) had a significantly lower proportion triaged as high urgent. Of those, strange or suicidal behaviour and general malaise had the highest odds ratio for the outcome ASRO: 1.4 (95% CI: 1.1-1.7) and 4.3 (95% CI: 3.8-5.0), respectively. Conclusion: Our study showed that the urgency allocation with telephone triage according to the NTS for patients with sepsis was suboptimal. The urgency allocation varied between the entrance complaints, of which some did not allocate urgency adequately.