PMID- 26458788
OWN - NLM
STAT- MEDLINE
DCOM- 20170103
LR  - 20170104
IS  - 0736-4679 (Print)
IS  - 0736-4679 (Linking)
VI  - 50
IP  - 4
DP  - 2016 Apr
TI  - Performance of the Manchester Triage System in Adult Medical Emergency Patients: 
      A Prospective Cohort Study.
PG  - 678-89
LID - 10.1016/j.jemermed.2015.09.008 [doi]
LID - S0736-4679(15)00938-5 [pii]
AB  - BACKGROUND: Accurate initial patient triage in the emergency department (ED) is
      pivotal in reducing time to effective treatment by the medical team and in
      expediting patient flow. The Manchester Triage System (MTS) is widely implemented
      for this purpose. Yet the overall effectiveness of its performance remains
      unclear. OBJECTIVES: We investigated the ability of MTS to accurately assess high
      treatment priority and to predict adverse clinical outcomes in a large unselected
      population of medical ED patients. METHODS: We prospectively followed consecutive
      medical patients seeking ED care for 30 days. Triage nurses implemented MTS upon 
      arrival of patients admitted to the ED. The primary endpoint was high initial
      treatment priority adjudicated by two independent physicians. Secondary endpoints
      were 30-day all-cause mortality, admission to the intensive care unit (ICU), and 
      length of stay. We used regression models with area under the receiver operating 
      characteristic curve (AUC) as a measure of discrimination. RESULTS: Of the 2407
      patients, 524 (21.8%) included patients (60.5 years, 55.7% males) who were
      classified as high treatment priority; 3.9% (n = 93) were transferred to the ICU;
      and 5.7% (n = 136) died. The initial MTS showed fair prognostic accuracy in
      predicting treatment priority (AUC 0.71) and ICU admission (AUC 0.68), but not in
      predicting mortality (AUC 0.55). Results were robust across most predefined
      subgroups, including patients diagnosed with infections, or cardiovascular or
      gastrointestinal diseases. In the subgroup of neurological symptoms and
      disorders, the MTS showed the best performance. CONCLUSION: The MTS showed fair
      performance in predicting high treatment priority and adverse clinical outcomes
      across different medical ED patient populations. Future research should focus on 
      further refinement of the MTS so that its performance can be improved. TRIAL
      REGISTRATION: Clinicaltrials.gov: NCT01768494.
CI  - Copyright (c) 2016 Elsevier Inc. All rights reserved.
FAU - Steiner, Deborah
AU  - Steiner D
AD  - University Department of Internal Medicine, Medical Faculty of the University of 
      Basel, Kantonsspital Aarau, Aarau, Switzerland.
FAU - Renetseder, Fabienne
AU  - Renetseder F
AD  - University Department of Internal Medicine, Medical Faculty of the University of 
      Basel, Kantonsspital Aarau, Aarau, Switzerland.
FAU - Kutz, Alexander
AU  - Kutz A
AD  - University Department of Internal Medicine, Medical Faculty of the University of 
      Basel, Kantonsspital Aarau, Aarau, Switzerland.
FAU - Haubitz, Sebastian
AU  - Haubitz S
AD  - University Clinic of Infectious Diseases, University Hospital Bern, Bern,
      Switzerland.
FAU - Faessler, Lukas
AU  - Faessler L
AD  - University Department of Internal Medicine, Medical Faculty of the University of 
      Basel, Kantonsspital Aarau, Aarau, Switzerland; Department of Psychology,
      University of Bern, Bern, Switzerland.
FAU - Anderson, Janet Byron
AU  - Anderson JB
AD  - Medical Linguistics Consulting, North Olmsted, Ohio.
FAU - Laukemann, Svenja
AU  - Laukemann S
AD  - University Department of Internal Medicine, Medical Faculty of the University of 
      Basel, Kantonsspital Aarau, Aarau, Switzerland.
FAU - Rast, Anna Christina
AU  - Rast AC
AD  - University Department of Internal Medicine, Medical Faculty of the University of 
      Basel, Kantonsspital Aarau, Aarau, Switzerland.
FAU - Felder, Susan
AU  - Felder S
AD  - University Department of Internal Medicine, Medical Faculty of the University of 
      Basel, Kantonsspital Aarau, Aarau, Switzerland.
FAU - Conca, Antoinette
AU  - Conca A
AD  - University Department of Internal Medicine, Medical Faculty of the University of 
      Basel, Kantonsspital Aarau, Aarau, Switzerland.
FAU - Reutlinger, Barbara
AU  - Reutlinger B
AD  - University Department of Internal Medicine, Medical Faculty of the University of 
      Basel, Kantonsspital Aarau, Aarau, Switzerland.
FAU - Batschwaroff, Marcus
AU  - Batschwaroff M
AD  - University Department of Internal Medicine, Medical Faculty of the University of 
      Basel, Kantonsspital Aarau, Aarau, Switzerland.
FAU - Tobias, Petra
AU  - Tobias P
AD  - University Department of Internal Medicine, Medical Faculty of the University of 
      Basel, Kantonsspital Aarau, Aarau, Switzerland.
FAU - Buergi, Ulrich
AU  - Buergi U
AD  - University Department of Internal Medicine, Medical Faculty of the University of 
      Basel, Kantonsspital Aarau, Aarau, Switzerland.
FAU - Mueller, Beat
AU  - Mueller B
AD  - University Department of Internal Medicine, Medical Faculty of the University of 
      Basel, Kantonsspital Aarau, Aarau, Switzerland.
FAU - Schuetz, Philipp
AU  - Schuetz P
AD  - University Department of Internal Medicine, Medical Faculty of the University of 
      Basel, Kantonsspital Aarau, Aarau, Switzerland.
LA  - eng
SI  - ClinicalTrials.gov/NCT01768494
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20151014
PL  - United States
TA  - J Emerg Med
JT  - The Journal of emergency medicine
JID - 8412174
SB  - IM
MH  - Emergency Service, Hospital/*organization & administration
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Injury Severity Score
MH  - Male
MH  - Middle Aged
MH  - *Outcome and Process Assessment (Health Care)
MH  - Prospective Studies
MH  - Switzerland
MH  - Triage/*methods
MH  - Wounds and Injuries/mortality/*therapy
OTO - NOTNLM
OT  - Manchester triage system
OT  - emergency department
OT  - injury severity
OT  - mortality
OT  - triage
EDAT- 2015/10/16 06:00
MHDA- 2017/01/04 06:00
CRDT- 2015/10/14 06:00
PHST- 2015/06/06 00:00 [received]
PHST- 2015/08/25 00:00 [revised]
PHST- 2015/09/04 00:00 [accepted]
PHST- 2015/10/14 06:00 [entrez]
PHST- 2015/10/16 06:00 [pubmed]
PHST- 2017/01/04 06:00 [medline]
AID - S0736-4679(15)00938-5 [pii]
AID - 10.1016/j.jemermed.2015.09.008 [doi]
PST - ppublish
SO  - J Emerg Med. 2016 Apr;50(4):678-89. doi: 10.1016/j.jemermed.2015.09.008. Epub
      2015 Oct 14.