Performance of the Manchester Triage System in Adult Medical Emergency Patients: A Prospective Cohort Study

Deborah Steiner; Fabienne Renetseder; Alexander Kutz; Sebastian Haubitz; Lukas Faessler; Janet Byron Anderson; Svenja Laukemann; Anna Christina Rast; Susan Felder; Antoinette Conca; Barbara Reutlinger; Marcus Batschwaroff; Petra Tobias; Ulrich Buergi; Beat Mueller; Philipp Schuetz

doi:10.1016/j.jemermed.2015.09.008

Performance of the Manchester Triage System in Adult Medical Emergency Patients: A Prospective Cohort Study

J Emerg Med. 2016 Apr;50(4):678-89. doi: 10.1016/j.jemermed.2015.09.008. Epub 2015 Oct 14.

Authors

Deborah Steiner¹, Fabienne Renetseder¹, Alexander Kutz¹, Sebastian Haubitz², Lukas Faessler³, Janet Byron Anderson⁴, Svenja Laukemann¹, Anna Christina Rast¹, Susan Felder¹, Antoinette Conca¹, Barbara Reutlinger¹, Marcus Batschwaroff¹, Petra Tobias¹, Ulrich Buergi¹, Beat Mueller¹, Philipp Schuetz¹

Affiliations

¹ University Department of Internal Medicine, Medical Faculty of the University of Basel, Kantonsspital Aarau, Aarau, Switzerland.
² University Clinic of Infectious Diseases, University Hospital Bern, Bern, Switzerland.
³ University Department of Internal Medicine, Medical Faculty of the University of Basel, Kantonsspital Aarau, Aarau, Switzerland; Department of Psychology, University of Bern, Bern, Switzerland.
⁴ Medical Linguistics Consulting, North Olmsted, Ohio.

PMID: 26458788
DOI: 10.1016/j.jemermed.2015.09.008

Abstract

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.

Keywords: Manchester triage system; emergency department; injury severity; mortality; triage.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Emergency Service, Hospital / organization & administration*
Female
Hospital Mortality
Humans
Injury Severity Score
Male
Middle Aged
Outcome and Process Assessment, Health Care*
Prospective Studies
Switzerland
Triage / methods*
Wounds and Injuries / mortality
Wounds and Injuries / therapy*

Associated data

ClinicalTrials.gov/NCT01768494