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Manchester triage system in paediatric emergency care: prospective observational study
Objective To validate use of the Manchester triage system in paediatric emergency care. Design Prospective observational study. Setting Emergency departments of a university hospital and a teaching hospital in the Netherlands, 2006-7. Participants 17 600 children (aged <16) visiting an emergency...
Autores principales: | , , , , , , |
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Formato: | Texto |
Lenguaje: | English |
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BMJ Publishing Group Ltd.
2008
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2548283/ https://www.ncbi.nlm.nih.gov/pubmed/18809587 http://dx.doi.org/10.1136/bmj.a1501 |
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author | van Veen, M Steyerberg, Ewout W Ruige, Madelon van Meurs, Alfred H J Roukema, Jolt van der Lei, Johan Moll, Henriette A |
author_facet | van Veen, M Steyerberg, Ewout W Ruige, Madelon van Meurs, Alfred H J Roukema, Jolt van der Lei, Johan Moll, Henriette A |
author_sort | van Veen, M |
collection | PubMed |
description | Objective To validate use of the Manchester triage system in paediatric emergency care. Design Prospective observational study. Setting Emergency departments of a university hospital and a teaching hospital in the Netherlands, 2006-7. Participants 17 600 children (aged <16) visiting an emergency department over 13 months (university hospital) and seven months (teaching hospital). Intervention Nurses triaged 16 735/17 600 patients (95%) using a computerised Manchester triage system, which calculated urgency levels from the selection of discriminators embedded in flowcharts for presenting problems. Nurses over-ruled the urgency level in 1714 (10%) children, who were excluded from analysis. Complete data for the reference standard were unavailable in 1467 (9%) children leaving 13 554 patients for analysis. Main outcome measures Urgency according to the Manchester triage system compared with a predefined and independently assessed reference standard for five urgency levels. This reference standard was based on a combination of vital signs at presentation, potentially life threatening conditions, diagnostic resources, therapeutic interventions, and follow-up. Sensitivity, specificity, and likelihood ratios for high urgency (immediate and very urgent) and 95% confidence intervals for subgroups based on age, use of flowcharts, and discriminators. Results The Manchester urgency level agreed with the reference standard in 4582 of 13 554 (34%) children; 7311 (54%) were over-triaged and 1661 (12%) under-triaged. The likelihood ratio was 3.0 (95% confidence interval 2.8 to 3.2) for high urgency and 0.5 (0.4 to 0.5) for low urgency; though the likelihood ratios were lower for those presenting with a medical problem (2.3 (2.2 to 2.5) v 12.0 (7.8 to 18.0) for trauma) and in younger children (2.4 (1.9 to 2.9) at 0-3 months v 5.4 (4.5 to 6.5) at 8-16 years). Conclusions The Manchester triage system has moderate validity in paediatric emergency care. It errs on the safe side, with much more over-triage than under-triage compared with an independent reference standard for urgency. Triage of patients with a medical problem or in younger children is particularly difficult. |
format | Text |
id | pubmed-2548283 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2008 |
publisher | BMJ Publishing Group Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-25482832008-09-23 Manchester triage system in paediatric emergency care: prospective observational study van Veen, M Steyerberg, Ewout W Ruige, Madelon van Meurs, Alfred H J Roukema, Jolt van der Lei, Johan Moll, Henriette A BMJ Research Objective To validate use of the Manchester triage system in paediatric emergency care. Design Prospective observational study. Setting Emergency departments of a university hospital and a teaching hospital in the Netherlands, 2006-7. Participants 17 600 children (aged <16) visiting an emergency department over 13 months (university hospital) and seven months (teaching hospital). Intervention Nurses triaged 16 735/17 600 patients (95%) using a computerised Manchester triage system, which calculated urgency levels from the selection of discriminators embedded in flowcharts for presenting problems. Nurses over-ruled the urgency level in 1714 (10%) children, who were excluded from analysis. Complete data for the reference standard were unavailable in 1467 (9%) children leaving 13 554 patients for analysis. Main outcome measures Urgency according to the Manchester triage system compared with a predefined and independently assessed reference standard for five urgency levels. This reference standard was based on a combination of vital signs at presentation, potentially life threatening conditions, diagnostic resources, therapeutic interventions, and follow-up. Sensitivity, specificity, and likelihood ratios for high urgency (immediate and very urgent) and 95% confidence intervals for subgroups based on age, use of flowcharts, and discriminators. Results The Manchester urgency level agreed with the reference standard in 4582 of 13 554 (34%) children; 7311 (54%) were over-triaged and 1661 (12%) under-triaged. The likelihood ratio was 3.0 (95% confidence interval 2.8 to 3.2) for high urgency and 0.5 (0.4 to 0.5) for low urgency; though the likelihood ratios were lower for those presenting with a medical problem (2.3 (2.2 to 2.5) v 12.0 (7.8 to 18.0) for trauma) and in younger children (2.4 (1.9 to 2.9) at 0-3 months v 5.4 (4.5 to 6.5) at 8-16 years). Conclusions The Manchester triage system has moderate validity in paediatric emergency care. It errs on the safe side, with much more over-triage than under-triage compared with an independent reference standard for urgency. Triage of patients with a medical problem or in younger children is particularly difficult. BMJ Publishing Group Ltd. 2008-09-22 /pmc/articles/PMC2548283/ /pubmed/18809587 http://dx.doi.org/10.1136/bmj.a1501 Text en © Veen et al 2008 http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research van Veen, M Steyerberg, Ewout W Ruige, Madelon van Meurs, Alfred H J Roukema, Jolt van der Lei, Johan Moll, Henriette A Manchester triage system in paediatric emergency care: prospective observational study |
title | Manchester triage system in paediatric emergency care: prospective observational study |
title_full | Manchester triage system in paediatric emergency care: prospective observational study |
title_fullStr | Manchester triage system in paediatric emergency care: prospective observational study |
title_full_unstemmed | Manchester triage system in paediatric emergency care: prospective observational study |
title_short | Manchester triage system in paediatric emergency care: prospective observational study |
title_sort | manchester triage system in paediatric emergency care: prospective observational study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2548283/ https://www.ncbi.nlm.nih.gov/pubmed/18809587 http://dx.doi.org/10.1136/bmj.a1501 |
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