title: The reliability of the Manchester Triage System (MTS): a meta-analysis.
abstract: OBJECTIVE
  Although the Manchester Triage System (MTS) was first developed two decades ago, the reliability of the MTS has not been questioned through comparison with a moderating variable; therefore, the aim of this study is to determine the extent of the reliability of MTS using a meta-analytic review.
  
  
  METHODS
  Electronic databases were searched up to 1 March 2014. Studies were only included if they had reported sample sizes, reliability coefficients, and adequate description of the reliability assessment. The Guidelines for Reporting Reliability and Agreement Studies was used. Two reviewers independently examined abstracts and extracted data. The effect size was obtained by the z-transformation of reliability coefficients. Data were pooled with random-effects models, and meta-regression was performed based on the method-of-moments estimator.
  
  
  RESULTS
  Seven studies were included. The pooled coefficient for the MTS was substantial at 0.751 (CI 95%: 0.677 to 0.810); the incidence of mistriage is greater than 50%. Agreement is higher for the latest version of MTS (for adults) among nurse-experts and in countries in closer proximity to the country of MTS origin (the UK, in Manchester) than for the oldest (pediatric) version, nurse-nurse raters, and countries at a greater distance from the UK.
  
  
  CONCLUSIONS
  The MTS showed an acceptable level of overall reliability in the emergency department, but more development is required to attain almost perfect agreement.
authors: Evidence-Based Caring Research Center, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
authors: Amir
authors: A
authors: Mirhaghi
authors: Evidence-Based Caring Research Center, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
authors: Reza
authors: R
authors: Mazlom
authors: Evidence-Based Caring Research Center, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
authors: Abbas
authors: A
authors: Heydari
authors: Department of Emergency Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors: Mohsen
authors: M
authors: Ebrahimi
mesh_terms: D004636:Emergency Service, Hospital; D006801:Humans; D015203:Reproducibility of Results; D018401:Sample Size; D014218:Triage / Q000379:methods*
keywords: Emergency treatment; Manchester Triage System; meta-analysis; reliability and validity; triage