Effectiveness of Manchester Triage System in risk prioritisation of patients with pulmonary embolism who present dyspnoea, chest pain or collapse

Zaboli, Arian; Turcato, Gianni; Solazzo, Pasquale; Sorrento, Daniele; Zorzi, Elisabetta; Marsoner, Tania; Magnarelli, Gabriele; Pfeifer, Norbert

doi:10.1016/j.ienj.2020.100842

Cited by 9 publications

(11 citation statements)

References 22 publications

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“…The sensitivity of the yellow category of the MTS for predicting an urgent and severe neurological condition underlying headache appears similar to that reported in previous studies on other symptoms and conditions (Gräff et al, 2017; Zaboli, Turcato, et al, 2020). Although a high sensitivity is important for a clinical diagnostic tool, it is less so for a triage system.…”

Section: Discussionsupporting

confidence: 88%

“…Although the MTS can provide an acceptable margin of safety due to the fact that it often assigns a low priority code to patients without urgent neurological conditions, it could not identify with acceptable accuracy cases with underlying urgent disorders and provide them with a high priority code. This inconsistency in the prioritisation of patients with headaches has also been reported in other MTS studies (Nishi et al, 2018; Zaboli, Turcato, et al, 2020; Zaboli et al, 2021). The MTS showed good accuracy and provided a high priority code in focal neurological deficits, in subjective but strongly schematisable symptoms (e.g.…”

Section: Discussionsupporting

confidence: 65%

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The Manchester Triage System's performance in clinical risk prioritisation of patients presenting with headache in emergency department: A retrospective observational study

Brigo

Zaboli

Rinaldi

et al. 2021

Journal of Clinical Nursing

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Objective Non‐traumatic headache is a frequent reason for visits to the emergency department (ED). We evaluated the performance of the Manchester Triage System (MTS) in prioritising patients presenting to the ED with non‐traumatic headache. Methods In this single‐centre observational retrospective study, we compared the association of MTS priority classification codes with a final diagnosis of a severe neurological condition requiring timely management (ischaemic or haemorrhagic stroke, subarachnoid haemorrhage, cerebral sinus venous thrombosis, central nervous system infection or brain tumour). The study was conducted and reported according to the STROBE statement. The overall prioritisation accuracy of MTS was estimated by the area under the receiver operating characteristic (ROC) curve. The correctness of triage prediction was estimated based on the “very urgent” MTS grouping. An undertriage was defined as a patient with an urgent and severe neurological who received a low priority/urgency MTS code (green/yellow). Results Over 30 months, 3002 triage evaluations of non‐traumatic headache occurred (1.7% of ED visits). Of these, 2.3% (68/3002) were eventually diagnosed with an urgent and severe neurological condition. The MTS had an acceptable prioritisation accuracy, with an area under the ROC curve of 0.734 (95% CI 0.668–0.799). The sensitivity of the MTS for urgent codes (yellow, orange and red) was 79.4% (95% CI 74.5–84.3), with a specificity of 54.1% (95% CI 52.9–55.3). The triage prediction was incorrect in only 6.3% (190/3002) of patients with headache. Conclusion The MTS is a safe and accurate tool for prioritising patients with non‐traumatic headache in the ED. However, MTS may need further specific tools for evaluating the more complicated symptoms and for correctly identifying patients with urgent and severe underlying pathologies. Relevance to clinical practice The triage nurse using MTS may need additional tools to improve the assessment of patients with headache, although MTS provides a good safety profile.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 65%

The Manchester Triage System's performance in clinical risk prioritisation of patients presenting with headache in emergency department: A retrospective observational study

Brigo

Zaboli

Rinaldi

et al. 2021

Journal of Clinical Nursing

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“…These studies should also focus on commonly missed diagnoses such as myocardial infarction and pulmonary embolism as these can be disguised by unspecific symptoms. The MTS has been found an acceptable tool for prioritising patients with symptoms of these diseases, but the current study does not allow extrapolation of these findings to the eMTS [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 97%

Triaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial

et al. 2021

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Objectives To determine whether a new triage system safely diverts a proportion of emergency department (ED) patients to a general practitioner cooperative (GPC). Methods Unblinded randomised controlled trial with weekends serving as clusters (three intervention clusters for each control). The intervention was triage by a nurse using a new extension to the Manchester Triage System assigning low-risk patients to the GPC. During intervention weekends, patients were encouraged to follow this assignment; it was not communicated during control weekends (all patients remained at the ED). The primary outcome was the proportion of patients assigned to and handled by the GPC during intervention weekends. The trial was randomised for the secondary outcome: the proportion of patients assigned to the GPC. Additional outcomes were association of these outcomes with possible confounders (study tool parameters, nurse, and patient characteristics), proportion of patients referred back to the ED by the GPC, hospitalisations, and performance of the study tool to detect primary care patients (the opinion of the treating physician was the gold standard). Results In the intervention group, 838/6294 patients (13.3%, 95% CI 12.5 to 14.2) were assigned to the GPC, in the control group this was 431/1744 (24.7%, 95% CI 22.7 to 26.8). In total, 599/6294 patients (9.5%, 95% CI 8.8 to 10.3) experienced the primary outcome which was influenced by the reason for encounter, age, and the nurse. 24/599 patients (4.0%, 95% CI 2.7 to 5.9) were referred back to the ED, three were hospitalised. Positive and negative predictive values of the studied tool during intervention weekends were 0.96 (95%CI 0.94 to 0.97) and 0.60 (95% CI 0.58 to 0.62). Out of the patients assigned to the GPC, 2.4% (95% CI 1.7 to 3.4) were hospitalised. Conclusions ED nurses using a new tool safely diverted 9.5% of the included patients to primary care. Trial registration ClinicalTrials.gov Identifier: NCT03793972

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“…For other cardiovascular symptoms, the MTS has demonstrated levels of sensitivity similar to those reported in the present study. Nishi et al (2018) in their study on the MTS and patients with chest pain in the ED, reported that the MTS had a sensitivity of approximately 44% for acute myocardial infarction, whereas in a recent study on the ability to prioritize patients with pulmonary embolism, the sensitivity of the MTS was only 35% (Nishi et al, 2018; Zaboli, Turcato, et al, 2020). A possible clinical explanation for this low discriminatory ability may lie in the fact that the levels of urgency are influenced by both the patient's account of symptoms and the clinical and parametric condition presented at triage.…”

Section: Discussionmentioning

confidence: 99%

Triage assessment of transitory loss of consciousness in the emergency department—A retrospective observational study

Zaboli

Ausserhofer

Sibilio

et al. 2021

Journal of Advanced Nursing

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Aim: To establish how the Manchester Triage System can correctly prioritize patients admitted to the emergency department for transitory loss of consciousness in relation to their risk of presenting severe acute disease. Design: A observational retrospective study. Methods: A total of 2291 patients who required a triage evaluation for a transitory loss of consciousness at the emergency department of Merano Hospital between 1 January 2017 and 30 June 2019 were considered. Transitory loss of consciousness was classified according to European Society of Cardiology guidelines. The baseline characteristics of the patients were collected and divided according to the priority level assigned at triage into two different study groups: high priority (red/orange) and low priority (blue/green/yellow). The composite outcome of the study was defined as the diagnosis of a severe acute disease. Results: Of the patients enrolled, 17% (390/2291) had a high-priority code and 83% (1901/2291) received a low-priority code. Overall, a severe acute disease was present in 16.9% of patients (387/2291). The Manchester Triage System had a sensitivity of 42.4%, a specificity of 88.1% and an accuracy of 80.4% for predicting severe acute disease. The discriminatory ability had an area under the receiver operating characteristic curve of 0.651 (CI 95%: 0.618-0.685).Conclusions: Despite the good specificity, the low sensitivity does not currently allow the Manchester Triage System to completely exclude patients with a severe acute disease who presented in the emergency department for a transitory loss of consciousness. Therefore, it is important to develop precise nursing tools or assessments that can improve triage performance. Impact:The assessment of a complex symptom can create difficulties in the stratification of patients in triage, assigning low-priority codes to patients with a severe disease. Additional tools are needed to allow the correct triage assessment of patients presenting with transitory loss of consciousness.

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Effectiveness of Manchester Triage System in risk prioritisation of patients with pulmonary embolism who present dyspnoea, chest pain or collapse

Cited by 9 publications

References 22 publications

The Manchester Triage System's performance in clinical risk prioritisation of patients presenting with headache in emergency department: A retrospective observational study

The Manchester Triage System's performance in clinical risk prioritisation of patients presenting with headache in emergency department: A retrospective observational study

Triaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial

Triage assessment of transitory loss of consciousness in the emergency department—A retrospective observational study

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