title: Safety of the Manchester Triage System to Detect Critically Ill Children at the Emergency Department.
abstract: To assess the safety of the Manchester Triage System in pediatric emergency care for children who require admission to the intensive care unit (ICU).
  
  
  
  Between 2006 and 2013, 50 062 consecutive emergency department visits of children younger than the age of 16 years were included. We determined the percentage of undertriage, defined as the proportion of children admitted to ICU triaged as low urgent according to the Manchester Triage System, and diagnostic performance measures, including sensitivity, specificity, and diagnostic OR. Characteristics of undertriaged patients were compared with correctly triaged patients. In a logistic regression model, risk factors for undertriage were determined.
  
  
  
  In total, 238 (28.7%) of the 830 children admitted to ICU during the study period were undertriaged. Sensitivity of high Manchester Triage System urgency levels to detect ICU admission was 71% (95% CI 68%-74%) and specificity 85% (95% CI 85%-85%). Severity of illness was lower in undertriaged children than correctly triaged children admitted to ICU. Risk factors for undertriage were age <3 months, medical presenting problem, comorbidity, referral by a medical specialist or emergency medical services, and presentation during the evening or night shift.
  
  
  
  The Manchester Triage System misclassifies a substantial number of children who require ICU admission. Modifications targeted at young children and children with a comorbid condition could possibly improve safety of the Manchester Triage System in pediatric emergency care.
authors.affiliation: Department of General Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Joany M
authors.initials: JM
authors.lastname: Zachariasse
authors.affiliation: Department of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Kuiper
authors.affiliation: Department of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Matthijs
authors.initials: M
authors.lastname: de Hoog
authors.affiliation: Department of General Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Henriëtte A
authors.initials: HA
authors.lastname: Moll
authors.affiliation: Department of General Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Pediatrics, Groene Hart Hospital, Gouda, The Netherlands. Electronic address: jped@mirjamvanveen.net.
authors.forename: Mirjam
authors.initials: M
authors.lastname: van Veen
mesh_terms: D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D008297:Male; D010343:Patient Admission; D061214:Patient Safety; D012307:Risk Factors; D014218:Triage / Q000592:standards*
keywords: emergency medical services; intensive care units; patient safety; pediatric; triage; validity