Manchester triage system in paediatric emergency care: prospective observational study

摘要: Objective To validate use of the Manchester triage system in paediatric emergency care. Design Prospective observational study. Setting Emergency departments a university hospital and teaching Netherlands, 2006-7. Participants 17 600 children (aged Intervention Nurses triaged 16 735/17 600 patients (95%) using computerised system, which calculated urgency levels from selection discriminators embedded flowcharts for presenting problems. over-ruled level 1714 (10%) children, who were excluded analysis. Complete data reference standard unavailable 1467 (9%) leaving 13 554 Main outcome measures Urgency according to compared with predefined independently assessed five levels. This was based on combination vital signs at presentation, potentially life threatening conditions, diagnostic resources, therapeutic interventions, follow-up. Sensitivity, specificity, likelihood ratios high (immediate very urgent) 95% confidence intervals subgroups age, flowcharts, discriminators. Results The agreed 4582 (34%) children; 7311 (54%) over-triaged 1661 (12%) under-triaged. ratio 3.0 (95% interval 2.8 3.2) 0.5 (0.4 0.5) low urgency; though lower those medical problem (2.3 (2.2 2.5) v 12.0 (7.8 18.0) trauma) younger (2.4 (1.9 2.9) 0-3 months 5.4 (4.5 6.5) 8-16 years). Conclusions has moderate validity It errs safe side, much more over-triage than under-triage an independent urgency. Triage or is particularly difficult.