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      The accuracy of the Manchester Triage System in an emergency service Translated title: Precisión del Sistema de Triaje Manchester en un servicio de emergencia Translated title: Acurácia do Sistema de Triagem de Manchester em um serviço de emergência

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          Abstract

          ABSTRACT Objective: To verify the accuracy of the Manchester Triage System (MTS) and the outcomes of adult patients in an emergency hospital service. Method: Cross-sectional study, conducted through an inspection of records of risk classification of adult patients treated in the emergency service of a hospital. Results: The patients (n = 400) were classified according to priority levels, in red (0.8%), orange (58.2%), and yellow (41.0%). The accuracy levels between auditors and nurses were substantial for the flowchart (K = 0.75), and moderate for discriminating factors (k = 0.46) and priority levels (k = 0.42). The accuracy of the MTS was 68.8% with regard to priority levels. Regarding outcomes, 60% of patients were discharged, 37% were transferred to other units, and 3% died. Conclusion: The MTS proved to be a good predictor of the assessed outcomes, showing that 65.9% of Low Urgency patients progress to discharges, and 3.8% of High Urgency patients progress to death. The accuracy of the MTS was moderate, which suggests the need to implement inspections in emergency services.

          Translated abstract

          RESUMEN Objetivo: Verificar la precisión del Sistema de Triaje Manchester (STM) y los resultados de pacientes adultos en un servicio de emergencia en un hospital. Método: estudio transversal, realizado a través de un proceso de auditoría de registros de detección con clasificación de riesgo de pacientes adultos tratados en un servicio hospitalario de emergencia. Resultados: Los pacientes (n = 400) se clasificaron según el nivel de prioridad en rojo (0.8%), naranja (58.2%) y amarillo (41.0%). Niveles de flujo de trabajo entre auditores y enfermeras (K = 0.75), moderados para discriminadores (k = 0.46) y nivel de prioridad (k = 0.42). La precisión del STM fue del 68.8% en el nivel de prioridad. En cuanto a los resultados, el 60% de los pacientes fueron dados de alta, el 37% fueron transferidos a otras unidades, el 3% falleció. Conclusión: El STM demostró ser un buen predictor de los resultados evaluados, mostrando que el 65.9% de los pacientes de baja urgencia progresa al alta y el 3.8% de los pacientes de alta urgencia progresa a la muerte. La precisión del STM fue moderada, lo que sugiere la necesidad de implementar auditorías en los servicios de emergencia.

          Translated abstract

          RESUMO Objetivo: Verificar a acurácia do Sistema de Triagem de Manchester (STM) e os desfechos dos pacientes adultos em um serviço de emergência hospitalar. Método: Estudo transversal, realizado por meio de um processo de auditoria dos registros de triagem com classificação de risco de pacientes adultos atendidos em um serviço de emergência hospitalar. Resultados: Os pacientes (n=400) foram classificados de acordo com o nível de prioridade em Vermelho (0,8%), Laranja (58,2%) e Amarelo (41,0%). A confiabilidade entre os auditores e enfermeiros foi substancial para fluxograma (K=0,75), moderada para discriminador (k=0,46) e nível de prioridade (k=0,42). A acurácia do STM foi de 68,8% no nível de prioridade. Em relação aos desfechos avaliados, 65,9% dos pacientes de Baixa Urgência evoluíram para alta, e 3,8% dos pacientes de Alta Urgência evoluíram para óbito. Conclusão: A acurácia do STM foi moderada. O STM se mostrou um bom preditor dos desfechos avaliados, evidenciando que a maioria dos pacientes de Baixa Urgência evoluem para alta, e 3,8% dos pacientes de Alta Urgência evoluem para óbito.

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          A systematic review on the validity and reliability of an emergency department triage scale, the Manchester Triage System.

          To conduct a systematic review to check the level of validity and reliability of the Manchester Triage System and the quality of reporting of literature on this topic.
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            Validity of the Manchester Triage System in emergency care: A prospective observational study

            Objectives 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.
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              The German Version of the Manchester Triage System and Its Quality Criteria – First Assessment of Validity and Reliability

              Background The German Version of the Manchester Triage System (MTS) has found widespread use in EDs across German-speaking Europe. Studies about the quality criteria validity and reliability of the MTS currently only exist for the English-language version. Most importantly, the content of the German version differs from the English version with respect to presentation diagrams and change indicators, which have a significant impact on the category assigned. This investigation offers a preliminary assessment in terms of validity and inter-rater reliability of the German MTS. Methods Construct validity of assigned MTS level was assessed based on comparisons to hospitalization (general / intensive care), mortality, ED and hospital length of stay, level of prehospital care and number of invasive diagnostics. A sample of 45,469 patients was used. Inter-rater agreement between an expert and triage nurses (reliability) was calculated separately for a subset group of 167 emergency patients. Results For general hospital admission the area under the curve (AUC) of the receiver operating characteristic was 0.749; for admission to ICU it was 0.871. An examination of MTS-level and number of deceased patients showed that the higher the priority derived from MTS, the higher the number of deaths (p<0.0001 / χ2 Test). There was a substantial difference in the 30-day survival among the 5 MTS categories (p<0.0001 / log-rank test).The AUC for the predict 30-day mortality was 0.613. Categories orange and red had the highest numbers of heart catheter and endoscopy. Category red and orange were mostly accompanied by an emergency physician, whereas categories blue and green were walk-in patients. Inter-rater agreement between expert triage nurses was almost perfect (κ = 0.954). Conclusion The German version of the MTS is a reliable and valid instrument for a first assessment of emergency patients in the emergency department.
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                Author and article information

                Journal
                rgenf
                Revista Gaúcha de Enfermagem
                Rev. Gaúcha Enferm.
                Universidade Federal do Rio Grande do Sul. Escola de Enfermagem (Porto Alegre, RS, Brazil )
                0102-6933
                1983-1447
                2020
                : 41
                : spe
                : e20190327
                Affiliations
                [1] Porto Alegre Rio Grande do Sul orgnameHospital de Clínicas de Porto Alegre orgdiv1Emergency Service Brasil
                [2] Porto Alegre Rio Grande do Sul orgnameUniversidade Federal de Ciências da Saúde de Porto Alegre orgdiv1Nursing Post-graduation Program Brazil
                Article
                S1983-14472020000200439 S1983-1447(20)04100000439
                10.1590/1983-1447.2020.20190327
                871aa50f-7736-4582-9474-93ca5ab0b2ea

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 06 March 2020
                : 27 September 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 19, Pages: 0
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                SciELO Revista de Enfermagem


                Auditoria clínica,Sensibilidade e especificidade,Confiabilidade dos dados,Serviço hospitalar de emergência,Triagem,Auditoría clínica,Sensibilidad y especificidad,Exactitud de los datos,Servicio de urgencia en hospital,Triaje,Clinical audit,Sensitivity and specificity,Data accuracy,Emergency service, hospital,Triage

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