Stroke recognition and early care pathways following telephone triage in out-of-hours primary care: a register-based study from the Central Denmark Region.

BACKGROUND

Out-of-hours primary care (OOH-PC) plays a key role in initial stroke triage, yet the accuracy of telephone assessments by general practitioners (GPs) and their impact on prehospital stroke care remain insufficiently studied.

AIMS: To evaluate the sensitivity of stroke and transient ischemic attack (TIA) identification by GPs during OOH-PC telephone triage and examine associations with time from first call to admission, treatment rates, and admission pathways.

PATIENTS AND

METHODS

We conducted a retrospective cohort study including patients admitted to stroke centers in the Central Denmark Region (2020-2022) following OOH-PC contact within 48 h. Triage classification was based on GP documentation and compared with final hospital diagnoses. Outcomes included triage sensitivity, intravenous thrombolysis (IVT) rates, and time to admission.

RESULTS

Among 4414 patients, 2738 had a final diagnosis of stroke or TIA, of whom 1728 were triage positive, corresponding to a sensitivity of 63.1% (95% CI, 61.2-64.9). Among patients with acute ischemic stroke (AIS) and symptom onset ≤3 h before OOH-PC contact, 387 of 544 were identified (71.1%, 95% CI, 67.2-74.8). Triage-positive AIS patients had higher IVT rates (adjusted difference: 8.9%, 95% CI, 5.4-12.5) and shorter call-to-admission time. In early-presenting AIS, the adjusted IVT difference was 10.9% (95% CI, 1.4-20.5), and triage-negative patients more often presented with impaired consciousness and visual symptoms.

CONCLUSIONS

GPs demonstrated moderate sensitivity in telephone triage of stroke in OOH-PC. Symptom presentation differed between triage groups, suggesting recognition may be influenced by symptom type as well as time from onset.