Manchester Triage in Sweden - interrater reliability and accuracy

Int Emerg Nurs. 2009 Jul;17(3):143-8. doi: 10.1016/j.ienj.2008.11.008. Epub 2009 Feb 5.


Introduction: This study investigates the interrater reliability and the accuracy of Manchester Triage (MTS) at emergency departments in Western Sweden.

Methods: A group of 79 nurses from seven emergency departments assessed simulated patient cases and assigned triage categories using the same principles as in their daily work. K statistics, accuracy, over-triage and under-triage were then analyzed. The nurses performed 1027 triage assessments.

Results: The result showed an unweighted kappa value of 0.61, a linear weighted kappa value of 0.71, and a quadratic weighted kappa value of 0.81. The determined accuracy was 92% and 91% for the two most urgent categories, but significantly lower for the less urgent categories.

Conclusions: Patients in need of urgent care were identified in more than nine out of 10 cases. The high level of over-triage and under-triage in the less urgent categories resulted in low agreement and accuracy. This may suggest that the resources of emergency departments can be overused for non-urgent patients.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Clinical Competence
  • Color
  • Decision Support Techniques*
  • Emergency Nursing / education
  • Emergency Nursing / methods*
  • Emergency Nursing / standards
  • Female
  • Humans
  • Linear Models
  • Male
  • Models, Nursing
  • Nursing Assessment / methods*
  • Nursing Assessment / standards
  • Nursing Evaluation Research
  • Observer Variation
  • Pilot Projects
  • Prospective Studies
  • Sensitivity and Specificity
  • Sweden
  • Time Factors
  • Triage / methods*
  • Triage / standards