How good is triage, and what is it good for?

Journal of Clinical Nursing

Ausserhofer

Pfeifer

et al. 2021

Objective Roughly 5% to 10% of patients admitted to the emergency department suffer from acute abdominal pain. Triage plays a key role in patient stratification, identifying patients who need prompt treatment versus those who can safely wait. In this regard, the aim of this study was to estimate the performance of the Manchester Triage System in classifying patients with acute abdominal pain. Methods A total of 9,851 patients admitted at the Emergency Department of the Merano Hospital with acute abdominal pain were retrospectively enrolled between 1 January 2017 and 30 June 2019. The study was conducted and reported according to the STROBE statement. The sensitivity and specificity of the Manchester Triage System were estimated by verifying the triage classification received by the patients and their survival at seven days or the need for acute surgery within 72 h after emergency department access. Results Among the patients with acute abdominal pain (median age 50 years), 0.4% died within seven days and 8.9% required surgery within 72 hours. The sensitivity was 44.7% (29.9–61.5), specificity was 95.4% (94.9–95.8), and negative predictive value was 99.7% (99.2–100) in relation to death at seven days. Conclusions The Manchester Triage System shows good specificity and negative predictive value. However, its sensitivity was low due to the amount of incorrect triage prediction in patients with high‐priority codes (red/orange), suggesting overtriage in relation to seven‐day mortality. This may be a protective measure for the patient. In contrast, the need for acute surgery within 72 h was affected by under‐triage. Relevance to clinical practice The triage nurse using Manchester Triage System can correctly prioritise the majority of patients with acute abdominal pain, especially in low acuity patients. The Manchester Triage System is safe and does not underestimate the severity of the patients.

Section: Discussionmentioning

confidence: 99%

Acute abdominal pain in triage: A retrospective observational study of the Manchester triage system’s validity

Journal of Clinical Nursing

Ausserhofer

Pfeifer

et al. 2021

“…To date, there is no gold standard for evaluating the effectiveness of triage systems. 15 In this study, the ability of MTS to correctly stratify patients with TGA by assigning them a priority code equivalent to yellow was assessed by the consensus of a panel of experts, as recommended by some authors. 16 Through this analysis, MTS was able to correctly stratify only 49.3% of patients (107/216), while 12.9% (28/216) were undertriaged and 37.8% (81/216) were overtriaged.…”

Section: Discussionmentioning

confidence: 99%

Validity of the Manchester triage system in the prioritization of patients with transient global amnesia in the emergency department

Neurology & Clinical Neurosc

Turcato

Nucera

et al. 2023

BackgroundThe Manchester Triage System (MTS) is one of the most widely used and studied triage systems in emergency departments (ED). MTS does not have a specific presentational flow chart for patients with transient global amnesia (TGA). The goal of this study was to determine the adequacy of priority code assignment for patients with TGA presenting at the ED and triaged using the MTS.MethodsThis is a single‐center observational retrospective study from January 01, 2013 to June 31, 2020. All patients with a medical diagnosis of TGA were considered. An audit was conducted on these triages to assess the correct application of MTS by the triage nurses. Correct triage was considered as a patient classified as yellow.ResultsDuring the study period, 216 patients with a diagnosis of TGA were considered. Of these 49.5% were classified as yellow, 13.0% were undertriage and classified as green or blue and 37.5% were overtriaged and classified as orange or red. The audit demonstrated that 98.8% of overtriaged patients and 57.1% of undertriage patients were triaged incorrectly. In addition, in 38 patients the triage nurse confused TGA with an acute neurological deficit suggestive of stroke or transient ischemic attack.ConclusionThe present study demonstrates an inability of MTS to correctly stratify patients with TGA. The results of the present study indicate the need for a specific flow chart for patients with neurological problems to improve the performance of MTS.

“…To date, there is a lack of a gold standard for efficacy assessment of different triage systems (Challen, 2017). In our real-life study, the MTS methodology was evaluated with regard to the effective prediction of an urgent neurological condition in patients complaining of headache and presenting to the ED.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have proposed assessing the validity of triage systems based upon predefined criteria set by experts in the field (Kuriyama et al, 2017). This might appear to be a pragmatic approach, but it is probably incomplete due to inadequate and insufficient patient and public involvement and the patchy insight of physicians about what patients might value (Challen, 2017; Kuriyama et al, 2017; Moll, 2010). Thus, we adopted a different approach, assessing the performance of the MTS in a real‐life scenario, using the final diagnosis of an urgent and severe neurological condition as a surrogate of severity related to urgency.…”

Section: Discussionmentioning

confidence: 99%

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

Brigo

Journal of Clinical Nursing

Rinaldi

et al. 2021

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.