Joany M Zachariasse1, Jan Willem Kuiper2, Matthijs de Hoog2, Henriëtte A Moll1, Mirjam van Veen3. 1. Department of General Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 2. Department of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. 3. Department of General Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Pediatrics, Groene Hart Hospital, Gouda, The Netherlands. Electronic address: jped@mirjamvanveen.net.
Abstract
OBJECTIVE: To assess the safety of the Manchester Triage System in pediatric emergency care for children who require admission to the intensive care unit (ICU). STUDY DESIGN: Between 2006 and 2013, 50 062 consecutive emergency department visits of children younger than the age of 16 years were included. We determined the percentage of undertriage, defined as the proportion of children admitted to ICU triaged as low urgent according to the Manchester Triage System, and diagnostic performance measures, including sensitivity, specificity, and diagnostic OR. Characteristics of undertriaged patients were compared with correctly triaged patients. In a logistic regression model, risk factors for undertriage were determined. RESULTS: In total, 238 (28.7%) of the 830 children admitted to ICU during the study period were undertriaged. Sensitivity of high Manchester Triage System urgency levels to detect ICU admission was 71% (95% CI 68%-74%) and specificity 85% (95% CI 85%-85%). Severity of illness was lower in undertriaged children than correctly triaged children admitted to ICU. Risk factors for undertriage were age <3 months, medical presenting problem, comorbidity, referral by a medical specialist or emergency medical services, and presentation during the evening or night shift. CONCLUSION: The Manchester Triage System misclassifies a substantial number of children who require ICU admission. Modifications targeted at young children and children with a comorbid condition could possibly improve safety of the Manchester Triage System in pediatric emergency care.
OBJECTIVE: To assess the safety of the Manchester Triage System in pediatric emergency care for children who require admission to the intensive care unit (ICU). STUDY DESIGN: Between 2006 and 2013, 50 062 consecutive emergency department visits of children younger than the age of 16 years were included. We determined the percentage of undertriage, defined as the proportion of children admitted to ICU triaged as low urgent according to the Manchester Triage System, and diagnostic performance measures, including sensitivity, specificity, and diagnostic OR. Characteristics of undertriaged patients were compared with correctly triaged patients. In a logistic regression model, risk factors for undertriage were determined. RESULTS: In total, 238 (28.7%) of the 830 children admitted to ICU during the study period were undertriaged. Sensitivity of high Manchester Triage System urgency levels to detect ICU admission was 71% (95% CI 68%-74%) and specificity 85% (95% CI 85%-85%). Severity of illness was lower in undertriaged children than correctly triaged children admitted to ICU. Risk factors for undertriage were age <3 months, medical presenting problem, comorbidity, referral by a medical specialist or emergency medical services, and presentation during the evening or night shift. CONCLUSION: The Manchester Triage System misclassifies a substantial number of children who require ICU admission. Modifications targeted at young children and children with a comorbid condition could possibly improve safety of the Manchester Triage System in pediatric emergency care.
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