title: Importance of Manchester Triage in acute myocardial infarction: impact on prognosis.
abstract: BACKGROUND
  Fast and effective diagnosis of patients with acute myocardial infarction (AMI) in the Emergency Department (ED) is needed. Manchester Triage (MT) is based on identification of the patient's main complaint, establishing, through decision flowcharts, a target-time for first observation. This study aimed to evaluate the impact of MT on short-term mortality in AMI and detect potential improvements, and to analyse high-risk groups: diabetic patients, women and older patients.
  
  
  METHODS
  332 consecutive patients (69.0+13.6 years mean age; 34.9% women) with final diagnosis of AMI were assessed in the ED using MT. Data were analysed according to demographics and risk groups, as well as several AMI parameters, admission duration and intrahospital mortality (IHM). Independent predictors of mortality were determined.
  
  
  RESULTS
  82.8% of patients met the ideal goal of ≤10 min target-time for a first observation (ITTFO). This was higher (95%) in typical presentations ('chest pain'), versus 52% in other flowcharts; p<0.01. Patients ≥70 years old were less frequently screened with ITTFO ≤10 min (76.2% vs 90.0% in those under 70; p=0.001) or the 'chest pain' flowchart (66.9% vs 77.5%; p=0.031). IHM was 13.3%. Triage with ≤10 min ITTFO and the 'chest pain' algorithm seems to predict a lower mortality (0.33 OR; 95% CI 0.17 to 0.63; p=0.0005 and 0.49 OR; 95% CI 0.24 to 1.03; p=0.056).
  
  
  CONCLUSIONS
  MT proved to be an effective system. Patients with typical AMI presentation, ST elevation myocardial infarction and less than 70 years old are protected by MT, with lower ITTFO and better short-term survival.
authors.affiliation: Department of Cardiology, Coimbra's Hospital Center, Coimbra, Portugal. rui_providencia@yahoo.com
authors.forename: Rui
authors.initials: R
authors.lastname: Providência
authors.forename: Pedro Lourenço
authors.initials: PL
authors.lastname: Gomes
authors.forename: Sérgio
authors.initials: S
authors.lastname: Barra
authors.forename: Joana
authors.initials: J
authors.lastname: Silva
authors.forename: Luís
authors.initials: L
authors.lastname: Seca
authors.forename: Alexandre
authors.initials: A
authors.lastname: Antunes
authors.forename: João Rosa
authors.initials: JR
authors.lastname: Pais
authors.forename: Paula
authors.initials: P
authors.lastname: Mota
authors.forename: António
authors.initials: A
authors.lastname: Leitão-Marques
mesh_terms: D000367:Age Factors; D000368:Aged; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis*; D011174:Portugal; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012737:Sex Factors; D012985:Software Design; D016019:Survival Analysis; D014218:Triage / Q000379:methods*