BACKGROUND: The Manchester Triage System (MTS) determines an inappropriately low level of urgency (undertriage) to a minority of children. The aim of the study was to assess the clinical severity of undertriaged patients in the MTS and to define the determinants of undertriage. METHODS: Patients who had attended the emergency department (ED) were triaged according to the MTS. Undertriage was defined as a 'low urgent' classification (levels 3, 4 and 5) under the MTS; as a 'high urgent' classification (levels 1 and 2) under an independent reference standard based on abnormal vital signs (level 1), potentially life-threatening conditions (level 2), and a combination of resource use, hospitalisation, and follow-up for the three lowest urgency levels. In an expert meeting, three experienced paediatricians used a standardised format to determine the clinical severity. The clinical severity had been expressed by possible consequences of treatment delay caused by undertriage, such as the use of more interventions and diagnostics, longer hospitalisation, complications, morbidity, and mortality. In a prospective observational study we used logistic regression analysis to assess predictors for undertriage. RESULTS: In total, 0.9% (119/13,408) of the patients were undertriaged. In 53% (63/119) of these patients, experts considered undertriage as clinically severe. In 89% (56/63) of these patients the high reference urgency was determined on the basis of abnormal vital signs. The prospective observational study showed undertriage was more likely in infants (especially those younger than three months), and in children assigned to the MTS 'unwell child' flowchart (adjusted OR<3 months 4.2, 95% CI 2.3 to 7.7 and adjusted ORunwell child 11.1, 95% CI 5.5 to 22.3). CONCLUSION: Undertriage is infrequent, but can have serious clinical consequences. To reduce significant undertriage, the authors recommend a systematic assessment of vital signs in all children.
BACKGROUND: The Manchester Triage System (MTS) determines an inappropriately low level of urgency (undertriage) to a minority of children. The aim of the study was to assess the clinical severity of undertriaged patients in the MTS and to define the determinants of undertriage. METHODS:Patients who had attended the emergency department (ED) were triaged according to the MTS. Undertriage was defined as a 'low urgent' classification (levels 3, 4 and 5) under the MTS; as a 'high urgent' classification (levels 1 and 2) under an independent reference standard based on abnormal vital signs (level 1), potentially life-threatening conditions (level 2), and a combination of resource use, hospitalisation, and follow-up for the three lowest urgency levels. In an expert meeting, three experienced paediatricians used a standardised format to determine the clinical severity. The clinical severity had been expressed by possible consequences of treatment delay caused by undertriage, such as the use of more interventions and diagnostics, longer hospitalisation, complications, morbidity, and mortality. In a prospective observational study we used logistic regression analysis to assess predictors for undertriage. RESULTS: In total, 0.9% (119/13,408) of the patients were undertriaged. In 53% (63/119) of these patients, experts considered undertriage as clinically severe. In 89% (56/63) of these patients the high reference urgency was determined on the basis of abnormal vital signs. The prospective observational study showed undertriage was more likely in infants (especially those younger than three months), and in children assigned to the MTS 'unwell child' flowchart (adjusted OR<3 months 4.2, 95% CI 2.3 to 7.7 and adjusted ORunwell child 11.1, 95% CI 5.5 to 22.3). CONCLUSION: Undertriage is infrequent, but can have serious clinical consequences. To reduce significant undertriage, the authors recommend a systematic assessment of vital signs in all children.
Authors: Shelley L McLeod; Cameron Thompson; Bjug Borgundvaag; Lehana Thabane; Howard Ovens; Steve Scott; Tamer Ahmed; Keerat Grewal; Joy McCarron; Brooke Filsinger; Nicole Mittmann; Andrew Worster; Thomas Agoritsas; Michael Bullard; Gordon Guyatt Journal: J Am Coll Emerg Physicians Open Date: 2020-04-21
Authors: Nienke Seiger; Mirjam van Veen; Helena Almeida; Ewout W Steyerberg; Alfred H J van Meurs; Rita Carneiro; Claudio F Alves; Ian Maconochie; Johan van der Lei; Henriëtte A Moll Journal: PLoS One Date: 2014-01-15 Impact factor: 3.240
Authors: Dorine Borensztajn; Shunmay Yeung; Nienke N Hagedoorn; Anda Balode; Ulrich von Both; Enitan D Carrol; Juan Emmanuel Dewez; Irini Eleftheriou; Marieke Emonts; Michiel van der Flier; Ronald de Groot; Jethro Adam Herberg; Benno Kohlmaier; Emma Lim; Ian Maconochie; Federico Martinón-Torres; Ruud Nijman; Marko Pokorn; Franc Strle; Maria Tsolia; Gerald Wendelin; Dace Zavadska; Werner Zenz; Michael Levin; Henriette A Moll Journal: BMJ Paediatr Open Date: 2019-06-27
Authors: Joany M Zachariasse; Ian K Maconochie; Ruud G Nijman; Susanne Greber-Platzer; Frank J Smit; Daan Nieboer; Johan van der Lei; Claudio F Alves; Henriëtte A Moll Journal: PLoS One Date: 2021-02-09 Impact factor: 3.240
Authors: Jeremiah S Hinson; Diego A Martinez; Paulo S K Schmitz; Matthew Toerper; Danieli Radu; James Scheulen; Sarah A Stewart de Ramirez; Scott Levin Journal: Int J Emerg Med Date: 2018-01-15
Authors: Marta Fernandes; Rúben Mendes; Susana M Vieira; Francisca Leite; Carlos Palos; Alistair Johnson; Stan Finkelstein; Steven Horng; Leo Anthony Celi Journal: PLoS One Date: 2020-04-02 Impact factor: 3.240