title: A systematic review on the validity and reliability of an emergency department triage scale, the Manchester Triage System.
abstract: OBJECTIVE
  To conduct a systematic review to check the level of validity and reliability of the Manchester Triage System and the quality of reporting of literature on this topic.
  
  
  METHODS
  This is a systematic review based on the PRISMA guideline on reporting systematic reviews.
  
  
  METHODS
  The systematic search of the international literature published from 1997 through 30 November 2012 in the PubMed, Embase, Cochrane Library, Cinahl, Web of Knowledge, and Scopus databases.
  
  
  METHODS
  This review included quantitative and qualitative research investigating the reliability and validity of the Manchester Triage System for the broad population of adults and children visiting the emergency department. After a systematic selection process, included studies were assessed on their quality by three researchers using the STARD guidelines.
  
  
  RESULTS
  Twelve studies were included in the review. The studies investigated the inter- and intra-rater reliability using the "kappa" statistic; the validity was tested with many measures: validity in predicting mortality, hospital admission, under- and overtriage, used resources, and length of stay in the emergency department, as well as a reference standard rating.
  
  
  CONCLUSIONS
  In this review, the Manchester Triage System shows a wide inter-rater agreement range with a prevalence of good and very good agreement. Its safety was low because of the high rate of undertriage and the low sensitivity in predicting higher urgency levels. The high rate of overtriage could cause unnecessarily high use of resources in the emergency department. The quality of the reporting in studies of the reliability and validity of the Manchester Triage System is good.
authors.affiliation: University of Parma, Parma, Italy. Electronic address: nipar71@yahoo.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Parenti
authors.affiliation: Biostatistic, University of Bologna, Italy.
authors.forename: Maria Letizia Bacchi
authors.initials: ML
authors.lastname: Reggiani
authors.affiliation: Department of Emergency Medicine of Hospital Lavagna, Genova, Italy.
authors.forename: Primiano
authors.initials: P
authors.lastname: Iannone
authors.affiliation: Administrative, University of Parma, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Percudani
authors.affiliation: Columbia University School of Nursing and Visiting Nursing Service of New York, New York, USA.
authors.forename: Dawn
authors.initials: D
authors.lastname: Dowding
mesh_terms: D000328:Adult; D002648:Child; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D014218:Triage
keywords: Emergency care; Emergency medical service; Literature review; Systematic review; Triage