Triage of patients with fever: The Manchester triage system's predictive validity for sepsis or septic shock and seven-day mortality

Journal of Clinical Nursing

Ausserhofer

Pfeifer

et al. 2021

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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: Methodsmentioning

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

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“…The triage evaluation of patients with respiratory or suspected infection symptoms is complex (Ausserhofer et al, 2020; Zaboli et al, 2020). Vital sign alterations (such as respiratory rate, oxygen saturation and temperature) that are recorded on ED admission do not always correlate with severe prognosis, and apparent conditions that suggest stable compensation may actually indicate very serious pulmonary involvement effectively compensated by large pulmonary functional reserves (Du et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

The ROX index can be a useful tool for the triage evaluation of COVID‐19 patients with dyspnoea

Journal of Advanced Nursing

Ausserhofer

Pfeifer

et al. 2021

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Aim To assess whether the application of a non‐invasive tool, such as ratio of oxygen saturation (ROX) index, during triage can identify patients with COVID‐19 at high risk of developing acute respiratory distress syndrome (ARDS). Design A multi‐centre, observational, retrospective study. Methods Only COVID‐19 positive patients who required an emergency department evaluation for dyspnoea were considered. The primary objective of the study was to compare the ROX value obtained during triage with the medical diagnosis of ARDS and intubation in 72 h of the triage evaluation. The ROX index value was also compared with objective outcomes, such as the pressure of arterial O2 (PaO2)/fraction of inspired oxygen (FiO2) ratio and the lung parenchyma volume involved in COVID‐19‐related inflammatory processes, based on 3D reconstructions of chest computed tomography (CT). Results During the study period, from 20 March 2020 until 31 May 2020, a total of 273 patients with confirmed SARS‐CoV‐2 infection were enrolled. The predictive ability of ROX for the risk of developing ARDS in 72 h after triage evaluation was associated with an area under the receiver operating characteristic (AUROC) of 0.845 (0.797–0.892, p < 0.001), whereas the AUROC value was 0.727 (0.634–0.821, p < 0.001) for the risk of intubation. ROX values were strongly correlated with PaO2/FiO2 values (r = 0.650, p < 0.001), decreased ROX values were associated with increased percentages of lung involvement based on 3D CT reconstruction (r = −0.371, p < 0.001). Conclusion The ROX index showed a good ability to identify triage patients at high evolutionary risk. Correlations with objective but more invasive indicators (PaO2/FiO2 and CT) confirmed the important role of ROX in identifying COVID‐19 patients with extensive pathological processes. Impact During the difficult triage evaluation of COVID‐19 patients, the ROX index can help the nurse to identify the real severity of the patient. The triage systems could integrate the ROX in the rapid patient assessment to stratify patients more accurately.

“…The F I G U R E 1 Receiver operating characteristic curve of the MTS in predicting a final diagnosis of urgent and severe neurological conditions Zaboli, Ausserhofer, et al, 2020;Zaboli et al, 2021). Furthermore, when a non-specific symptom is isolated (e.g.…”

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

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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.