Evaluating the Manchester Triage System in Children's Emergency Care
Author Information
Author(s): van Veen M, Steyerberg Ewout W, Ruige Madelon, van Meurs Alfred H J, Roukema Jolt, van der Lei Johan, Moll Henriette A
Primary Institution: Erasmus Medical Centre, Sophia Children’s Hospital, University Medical Centre Rotterdam
Hypothesis
To validate the use of the Manchester triage system in paediatric emergency care.
Conclusion
The Manchester triage system has moderate validity in paediatric emergency care, with more over-triage than under-triage compared to an independent reference standard.
Supporting Evidence
- The Manchester urgency level agreed with the reference standard in 34% of cases.
- 54% of children were over-triaged and 12% under-triaged.
- The sensitivity for high urgency was 63%, meaning many patients needing immediate care were not categorized as such.
- Specificity was 79%, indicating some low urgency patients were categorized too high.
- Validity was particularly low for children presenting with medical problems compared to trauma.
Takeaway
The Manchester triage system helps doctors decide how urgent a child's medical problem is, but it sometimes says a child needs help faster than they really do.
Methodology
A prospective observational study comparing urgency categories assigned by the Manchester triage system with a predefined independent reference classification.
Potential Biases
Nurses over-ruled the urgency category in 10% of patients, which could affect validity.
Limitations
The reference standard was based on expert opinion and may not reflect an ideal standard; also, 9% of data were missing.
Participant Demographics
Children aged under 16 attending emergency departments in the Netherlands; median age was 3.4 years.
Statistical Information
Confidence Interval
95% confidence interval for likelihood ratios provided.
Digital Object Identifier (DOI)
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