Publication
Improving the Manchester Triage System for pediatric emergency care: an international multicenter study
| dc.contributor.author | Seiger, N | |
| dc.contributor.author | van Veen, N | |
| dc.contributor.author | Almeida, HI | |
| dc.contributor.author | Steyerberg, E | |
| dc.contributor.author | van Meurs, A | |
| dc.contributor.author | Carneiro, R | |
| dc.contributor.author | Alves, C | |
| dc.contributor.author | Maconochie, I | |
| dc.contributor.author | van der Lei, J | |
| dc.contributor.author | Moll, H | |
| dc.date.accessioned | 2015-08-26T15:44:03Z | |
| dc.date.available | 2015-08-26T15:44:03Z | |
| dc.date.issued | 2014 | |
| dc.description.abstract | 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 0-2 months [corrected] 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. | por |
| dc.identifier.citation | PLoS One. 2014 Jan 15;9(1):e83267 | por |
| dc.identifier.doi | 10.1371/journal.pone.0083267 | |
| dc.identifier.uri | http://hdl.handle.net/10400.10/1520 | |
| dc.language.iso | eng | por |
| dc.peerreviewed | yes | por |
| dc.publisher | Public Library of Science | por |
| dc.relation.publisherversion | http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893080/pdf/pone.0083267.pdf | por |
| dc.subject | Manchester triage system | por |
| dc.subject | Paediatric emergency care | por |
| dc.subject | Hospital emergency service | por |
| dc.subject | Triage | por |
| dc.subject | Child | por |
| dc.title | Improving the Manchester Triage System for pediatric emergency care: an international multicenter study | por |
| dc.type | journal article | |
| dspace.entity.type | Publication | |
| oaire.citation.conferencePlace | San Francisco | por |
| oaire.citation.title | PloS one | por |
| oaire.citation.volume | 9 | por |
| rcaap.rights | openAccess | por |
| rcaap.type | article | por |