Abstract
Background: In the Netherlands, a digital decision support system for telephone triage at out-of-hours services in primary care (OHS-PC) is used. Differences in help-seeking behavior between men and women when transient ischemic attack (TIA) or stroke is suspected could potentially affect telephone triage and allocation of urgency.Aim: To assess patient and call characteristics and allocated urgencies between women and men who contacted OHS-PC with suspected TIA/stroke.Methods: A cross-sectional study of 1,266 telephone triage recordings of subjects with suspected neurological symptoms calling the OHS-PC between 2014 and 2016. The allocated urgencies were derived from the electronic medical records of the OHS-PC and the final diagnosis from the patient's own general practitioner, including diagnoses based on hospital specialist letters.Results: Five hundred forty-six men (mean age = 67.3 ± 17.1) and 720 women (mean age = 69.6 ± 19.5) were included. TIA/stroke was diagnosed in 294 men (54%) (mean age = 72.3 ± 13.6) and 366 women (51%) (mean age = 78.0 ± 13.8). In both genders, FAST (face-arm-speech test) symptoms were common in TIA/stroke (men 78%, women 82%) but also in no TIA/stroke (men 63%, women 62%). Men with TIA/stroke had shorter call durations than men without TIA/stroke (7.10 vs. 8.20 min, p = 0.001), whereas in women this difference was smaller and not significant (7.41 vs. 7.56 min, p = 0.41). Both genders were allocated high urgency in 75% of the final TIA/stroke cases.Conclusion: Overall, patient and call characteristics are mostly comparable between men and women, and these only modestly assist in identifying TIA/stroke. There were no gender differences in allocated urgencies after telephone triage in patients with TIA/stroke.
Highlights
Recognition and timely diagnosis of patients with a transient ischemic attack (TIA) or stroke are vital to initiate interventions that can improve outcome and prevent recurrent stroke [1,2,3]
The triage recordings were selected in a two-step inclusion procedure, i.e., (i) selection based on the International Classification of Primary Care (ICPC) codes that are linked to the call and reflected our study domain (i.e., K89, K90, N17, N18, N19, N29, N89, N91) and (ii) keywords in the of-hours services in primary care (OHS-PC) electronic medical records suggesting TIA/stroke [14]
The face-armspeech test [FAST; (1≥) face dropping, arm weakness, speech problem] was positive in 72% and atypical symptoms were reported in 42% of the patients
Summary
Recognition and timely diagnosis of patients with a transient ischemic attack (TIA) or stroke are vital to initiate interventions that can improve outcome and prevent recurrent stroke [1,2,3]. There are even studies that have reported that women are more likely to delay seeking help compared to men [7, 8]. A strong association has been reported between advice by others to seek help and shorter reaction times emphasizing the importance of intervention by family members or significant others [7]. Differences in help-seeking behavior between men and women when transient ischemic attack (TIA) or stroke is suspected could potentially affect telephone triage and allocation of urgency
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