title: Validity of the Manchester Triage System in patients with sepsis presenting at the ED: a first assessment.
abstract: BACKGROUND
  The Manchester Triage System (MTS) does not have a specific presentational flow chart for sepsis. The goal of this investigation was to determine adequacy of acuity assignment for patients with sepsis presenting at the ED and triaged using the MTS.
  
  
  METHODS
  This retrospective analysis included patients >16 presenting to an ED in Bonn, Germany, on the first 12 days of each month between June 2012 and March 2014. Patients were classified into one of three septic groups, or no sepsis. For those with sepsis, adequacy of acuity assignment was based on the criteria of the first consensus conference of the American College of Chest Physicians and Society of Critical Care Medicine, first published in 1992. Adequacy of prioritisation is expressed as sensitivity and likelihood ratio (LR-).
  
  
  RESULTS
  Among 20 836 patients evaluated, 801 (3.8%) were septic; of these, 581 (72.5%) had sepsis, 194 (24.2%) had severe sepsis and 26 (3.2%) had severe sepsis with circulation dysfunction. Patients who met the criteria for sepsis were correctly prioritised with a sensitivity of 70.4% (95% CI 66.5 to 74.0). The LR- was 0.628 (95% CI 0.564 to 0.698). Patients with severe sepsis were appropriately prioritised with a sensitivity of 84.5% (95% CI 78.1 to 89.4), and LR- was 0.330 (95% CI 0.243 to 0.450). In the group with severe sepsis and circulation dysfunction, sensitivity of MTS was 61.5% (95% CI 39.3 to 79.8), and LR- was 0.466 (95% CI 0.286 to 0.757).
  
  
  CONCLUSIONS
  The MTS has some weaknesses regarding priority levels in emergency patients with septic illness. Overall, target key symptoms (discriminators) which aim at identifying systemic infection and ascertaining vital parameters are insufficiently considered.
authors.affiliation: Emergency Department, University Hospital Bonn, Bonn, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Gräff
authors.affiliation: Department of Process Management, University Hospital Bonn, Bonn, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Goldschmidt
authors.affiliation: Emergency Department, University Hospital Bonn, Bonn, Germany.
authors.forename: Procula
authors.initials: P
authors.lastname: Glien
authors.affiliation: Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany.
authors.forename: Ramona C
authors.initials: RC
authors.lastname: Dolscheid-Pommerich
authors.affiliation: Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Fimmers
authors.affiliation: Department of Anesthesiology, University Hospital Bonn, Bonn, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grigutsch
mesh_terms: D000328:Adult; D000368:Aged; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis*; D014218:Triage / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data
keywords: emergency department; triage