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

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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.

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