title: A comparison of emergency triage scales in triaging poisoned patients.
abstract: BACKGROUND
  Triage of toxicology patients presents a challenge due to their complexity, underlying psychosocial issues, and additional pharmacological considerations. Two emergency department triage systems used in Australia, the Australasian Triage Scale (ATS) and the Manchester Triage System (MTS), were compared in triaging patients presenting with poisoning and envenoming.
  
  
  METHODS
  In this simulation-based study, 30 triage nurses from three hospitals were given 8 tabletop scenarios and asked to provide a triage category. 20 nurses from two hospitals using the ATS, and 10 nurses from a third hospital using the MTS, triaged 8 scenarios, grouped into "commonly encountered" (n=4) and "rarely encountered" (n=4). Triage systems and scenario groups were compared for median triage category and variance in scoring. Triage nurses also noted if they would seek help from toxicology services or the poisons information centre (PIC) for advice.
  
  
  RESULTS
  Overall, MTS nurses triaged all 8 scenarios with a lower acuity triage category, though statistically significant for only 3 scenarios. ATS nurses scored higher acuity triage category in all 4 "rare" highly toxic presentations, whereas MTS nurses scored higher acuity when vital signs were abnormal. MTS showed wider variance in triage scores in both scenario groups when compared to the ATS. Triage nurses without access to local toxicology services chose to contact PIC in most cases.
  
  
  CONCLUSIONS
  When compared to the ATS, MTS gave a lower acuity triage score for all common and rarely encountered poisoning scenario groups, which included highly toxic ingestions that appear well at triage but may progress to severe poisoning. Triage nurses should refer to information on highly toxic exposures and envenomation guidelines during their triage risk assessment.
authors.affiliation: Emergency Department, Westmead Hospital, Sydney, Australia; Emergency Department, Blacktown-Mt.Druitt Hospital, Sydney, Australia; Department of Clinical Pharmacology & Toxicology, Western Sydney LHD, Sydney, Australia; School of Medicine, University of Western Sydney, NSW, Australia. Electronic address: dushan.jayaweera@health.nsw.gov.au.
authors.forename: Dushan
authors.initials: D
authors.lastname: Jayaweera
authors.affiliation: Emergency Department, Westmead Hospital, Sydney, Australia; Emergency Department, Blacktown-Mt.Druitt Hospital, Sydney, Australia; Department of Clinical Pharmacology & Toxicology, Western Sydney LHD, Sydney, Australia; School of Medicine, University of Western Sydney, NSW, Australia.
authors.forename: Satish
authors.initials: S
authors.lastname: Mitter
authors.affiliation: Emergency Department, Nepean Hospital, Sydney, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Grouse
authors.affiliation: Emergency Department, Blacktown-Mt.Druitt Hospital, Sydney, Australia.
authors.forename: Luke
authors.initials: L
authors.lastname: Strachan
authors.affiliation: Emergency Department, Westmead Hospital, Sydney, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Murphy
authors.affiliation: Emergency Department, Blacktown-Mt.Druitt Hospital, Sydney, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Douglass
authors.affiliation: Emergency Department, Nepean Hospital, Sydney, Australia.
authors.forename: Liesel
authors.initials: L
authors.lastname: Gerlach
authors.affiliation: Emergency Department, Westmead Hospital, Sydney, Australia; Emergency Department, Blacktown-Mt.Druitt Hospital, Sydney, Australia; Department of Clinical Pharmacology & Toxicology, Western Sydney LHD, Sydney, Australia; Discipline of Emergency Medicine, Sydney Medical School, NSW, Australia; School of Medicine, University of Western Sydney, NSW, Australia.
authors.forename: Naren
authors.initials: N
authors.lastname: Gunja
mesh_terms: D002983:Clinical Competence / Q000592:standards; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D016529:Emergency Nursing / Q000592:standards; D004636:Emergency Service, Hospital / Q000592:standards; D006801:Humans; D009517:New South Wales; D009741:Nursing Staff, Hospital; D011041:Poisoning / Q000175:diagnosis*; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D014218:Triage / Q000379:methods* / Q000592:standards
keywords: Emergency nursing; Poison control centres; Risk assessment; Toxicology; Triage