ArticleFamily practice2026
Performance of the Dutch Triage standard in managing fever in children in out-of-hours primary care: a secondary analysis of the chili study.
Article in Family practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
objectivesThe Dutch Triage Standard (NTS) supports nurses in assessing case urgency in out-of-hours general practice (GP) care; however, its suitability for fever-related pediatric cases remains debated. This study examines the agreement between pre-consultation NTS urgency classifications (U-scores) and post-consultation management decisions in febrile children, and whether the NTS reduces between-center variation in decision-making.
methodsWe performed a secondary analysis of the CHILI study, including 22 089 consultations for children under 12 with fever, across 18 out-of-hours GP centers (2015- 2016). Adjusted logistic regression models, with natural cubic splines and random intercepts, explored the associations between U-scores and three outcomes: referral to secondary care, antibiotic prescription, and other medication use. Intraclass correlation coefficients assessed between-center variability.
resultsUnadjusted and adjusted percentages of the three outcomes showed similar trends. 24.5% of consultations were classified at low urgency levels (U4-5) before the consultation. Adjusted referral probabilities decreased with lower urgency: 29% (U1) to 0.8% (U5). Strikingly, antibiotic prescription rates were highest for U3 (26.2%) and U4 (25.1%). The probability of other medication prescriptions decreased steadily across urgency levels. ICCs revealed low between-center variability, which did not decrease after accounting for U-scores.
conclusionsHigher NTS urgency classifications are associated with increased referral rates during fever-related out-of-hours GP consultations. However, overall referral rates remain low, while a substantial number of consultations are pre-classified by the NTS as low urgency, contributing to a high workload of unnecessary consultations that highlights the need for more efficient triage and resource allocation.
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