Validity of the Manchester Triage System in emergency care: A prospective observational study.
OBJECTIVE
To determine the validity of the Manchester Triage System (MTS) in emergency care for the general population of patients attending the emergency department, for children and elderly, and for commonly used MTS flowcharts and discriminators across three different emergency care settings.


METHODS
This was a prospective observational study in three European emergency departments. All consecutive patients attending the emergency department during a 1-year study period (2010-2012) were included. Validity of the MTS was assessed by comparing MTS urgency as determined by triage nurses with patient urgency according to a predefined 3-category reference standard as proxy for true patient urgency.


RESULTS
288,663 patients were included in the analysis. Sensitivity of the MTS in the three hospitals ranged from 0.47 (95%CI 0.44-0.49) to 0.87 (95%CI 0.85-0.90), and specificity from 0.84 (95%CI 0.84-0.84) to 0.94 (95%CI 0.94-0.94) for the triage of adult patients. In children, sensitivity ranged from 0.65 (95%CI 0.61-0.70) to 0.83 (95%CI 0.79-0.87), and specificity from 0.83 (95%CI 0.82-0.83) to 0.89 (95%CI 0.88-0.90). The diagnostic odds ratio ranged from 13.5 (95%CI 12.1-15.0) to 35.3 (95%CI 28.4-43.9) in adults and from 9.8 (95%CI 6.7-14.5) to 23.8 (95%CI 17.7-32.0) in children, and was lowest in the youngest patients in 2 out of 3 settings and in the oldest patients in all settings. Performance varied considerably between the different emergency departments.


CONCLUSIONS
Validity of the MTS in emergency care is moderate to good, with lowest performance in the young and elderly patients. Future studies on the validity of triage systems should be restricted to large, multicenter studies to define modifications and improve generalizability of the findings.
Department of General Paediatrics, Erasmus MC- Sophia Children's Hospital, Rotterdam, The Netherlands.
Joany M
JM
Zachariasse
Department of General Paediatrics, Erasmus MC- Sophia Children's Hospital, Rotterdam, The Netherlands.
Nienke
N
Seiger
Department of Emergency Medicine, Erasmus MC, Rotterdam, The Netherlands.
Pleunie P M
PP
Rood
Department of Paediatrics, Emergency Unit, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal.
Claudio F
CF
Alves
Intensive Care Unit, Hospital Professor Doutor Fernando da Fonseca, Amadora, Lisbon, Portugal.
Paulo
P
Freitas
Department of Paediatrics, Maasstad Hospital, Rotterdam, The Netherlands.
Frank J
FJ
Smit
Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands.
Gert R
GR
Roukema
Department of General Paediatrics, Erasmus MC- Sophia Children's Hospital, Rotterdam, The Netherlands.
Henriëtte A
HA
Moll
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012985:Software Design; D014218:Triage / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D055815:Young Adult