title: The Manchester triage system: improvements for paediatric emergency care.
abstract: OBJECTIVE
  To improve the Manchester Triage System (MTS) in paediatric emergency care.
  
  
  METHODS
  The authors performed a prospective observational study at the emergency departments of a university and teaching hospital in The Netherlands and included children attending in 2007 and 2008. The authors developed and implemented specific age-dependent modifications for the MTS, based on patient groups where the system's performance was low. Nurses applied the modified system in 11,481 (84%) patients. The reference standard for urgency defined five levels based on a combination of vital signs at presentation, potentially life-threatening conditions, diagnostic resources, therapeutic interventions and follow-up. The reference standard for urgency was previously defined and available in 11,260/11,481 (96%) patients.
  
  
  RESULTS
  Compared with the original MTS specificity improved from 79% (95% CI 79% to 80%) to 87% (95% CI 86% to 87%) while sensitivity remained similar ((63%, 95% CI 59% to 66%) vs (64%, 95% CI 60% to 68%)). The diagnostic OR increased (4.1 vs 11).
  
  
  CONCLUSIONS
  Modifications of the MTS for paediatric emergency care resulted in an improved specificity while sensitivity remained unchanged. Further research should focus on the improvement of sensitivity.
authors.affiliation: Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. h.a.moll@erasmusmc.nl
authors.forename: Mirjam
authors.initials: M
authors.lastname: van Veen
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Mariët
authors.initials: M
authors.lastname: Van't Klooster
authors.forename: Madelon
authors.initials: M
authors.lastname: Ruige
authors.forename: Alfred H J
authors.initials: AH
authors.lastname: van Meurs
authors.forename: Johan
authors.initials: J
authors.lastname: van der Lei
authors.forename: Henriëtte A
authors.initials: HA
authors.lastname: Moll
mesh_terms: D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009426:Netherlands; D010371:Pediatric Nursing / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D010372:Pediatrics / Q000458:organization & administration* / Q000592:standards; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014218:Triage / Q000458:organization & administration* / Q000592:standards