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

Abstract

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.

Characteristics of eye-related emergency visits and triage differences by nurses and ophthalmologists: Perspective from a single eye center in southern China

“…First, ophthalmic crises were concentrated on ocular disorders and had fewer considerations than general ED visits, which must take into account systemic manifestations. Second, most general EDs employed a four-or five-level classification system ( [27][28][29], which made triage more challenging for nurses than the three-level triage in our study. Interestingly, although we confirmed that there was strong agreement between nurses and doctors, we discovered that nurses tended to give a "semi-emergency" grade to all patients.…”

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

“…pathologies, with an overtriage rate ranging from 7.6% to 54%. 10,18 Overtriage leads to problems in the ED management of patient flow, as patients with benign disorders are visited earlier than those with urgent and time-dependent pathology. It results also in a prolonged ED stay and an increased number of unnecessary diagnostic procedures.…”

“…Recently, different studies have focused on evaluating the performance of MTS on individual symptom presentations, reporting conflicting results about its ability. While some studies have demonstrated a good ability of MTS to correctly identify and stratify certain symptoms and specific pathologies (e.g., chest pain, headache, and dyspnea), for other symptoms it has revealed a lower ability to prioritize patients with time‐dependent pathologies (e.g., cardiac syncope and pulmonary embolism) 7,8,10–13 …”

“…While some studies have demonstrated a good ability of MTS to correctly identify and stratify certain symptoms and specific pathologies (e.g., chest pain, headache, and dyspnea), for other symptoms it has revealed a lower ability to prioritize patients with time-dependent pathologies (e.g., cardiac syncope and pulmonary embolism). 7,8,[10][11][12][13] Difficulties in promptly and accurately recognizing TGA in the ED setting during the triage process could lead to incorrect priority codes assigned to patients (overtriage), resulting in inappropriate use of resources. The study aims to analyze the performance of MTS in the assessment of patients with a diagnosis of TGA.…”

Daily triage audit can improve nurses' triage stratification: A pre–post study

“…Different studies in the literature have attempted to evaluate the accuracy of triage systems, both globally and when comparing time‐dependent pathologies, by studying the correct stratification of patients (Azeredo et al, 2015; Brigo et al, 2022; Zaboli, Ausserhofer, Sibilio, Paulmichl, Toccolini, Losi, et al, 2022). In such studies, the triage priority code was always correlated with the patient's clinical outcome; unfortunately, only a few and limited studies have performed subsequent evaluations about the type of error to understand whether it was depending on a wrong application of the triage system or whether it was a problem present within the triage system itself (Brigo et al, 2022; Zaboli et al, 2020).…”