Arian Zaboli1, Gianni Turcato2, Pasquale Solazzo3, Daniele Sorrento4, Elisabetta Zorzi5, Tania Marsoner1, Gabriele Magnarelli3, Norbert Pfeifer3. 1. Department of Emergency Medicine, Franz Tappeiner Hospital of Merano, Azienda Sanitaria dell'Alto Adige, Merano 39012 (BZ), Bolzano, Italy. 2. Department of Emergency Medicine, Franz Tappeiner Hospital of Merano, Azienda Sanitaria dell'Alto Adige, Merano 39012 (BZ), Bolzano, Italy. Electronic address: gianni.turcato@yahoo.it. 3. Department of Emergency Medicine, Franz Tappeiner Hospital of Merano, Azienda Sanitaria dell'Alto Adige, Merano 39012 (BZ), Bolzano, Italy; Manchester Triage Group Italy, Merano 39012 (BZ), Bolzano, Italy. 4. Management Center Innsbruck, Innsbruck 6020, Austria. 5. Department of Cardiology, Girolamo Fracastoro Hospital of San Bonifacio, Azienda Ospedaliera Scaligera, San Bonifacio 37047 (VR), Verona, Italy.
Abstract
BACKGROUND: Recognising patients with pulmonary embolism continues to be a clinical challenge. In the Emergency Department, up to 50% of patients with pulmonary embolism can be delayed or even misdiagnosed. The ability of a triage system to correctly prioritise suspected embolism in these patients is fundamental for determining diagnostic-therapeutic procedures. AIM: To verify the effectiveness of the Manchester Triage System in risk prioritisation of patients with pulmonary embolism who present with dyspnoea, chest pain, or collapse. METHODS: In this observational, retrospective, study the sensitivity, specificity, and positive and negative predictive values of the Manchester Triage System were calculated using the triage classification for these patients, and their established diagnoses. The analysis included baseline characteristics and triage evaluations. RESULTS: During the two-year study period, 7055 patients were enrolled. Pulmonary embolism episodes were 2.1% of all cases, while severe pulmonary embolisms were 0.8%. The estimated specificity of the Manchester Triage System was 72.5% (CI 95%, 71.5-73.6), and the negative predictive value was 98.1% (CI 95%, 97.7-98.5). The results suggest that clinical characteristics leading to a high Manchester Triage System priority are similar to those characterising a pulmonary embolism episode. CONCLUSIONS: Although pulmonary embolism is difficult to diagnose, the Manchester Triage System is an effective tool for prioritising patients with symptoms of this disease.
BACKGROUND: Recognising patients with pulmonary embolism continues to be a clinical challenge. In the Emergency Department, up to 50% of patients with pulmonary embolism can be delayed or even misdiagnosed. The ability of a triage system to correctly prioritise suspected embolism in these patients is fundamental for determining diagnostic-therapeutic procedures. AIM: To verify the effectiveness of the Manchester Triage System in risk prioritisation of patients with pulmonary embolism who present with dyspnoea, chest pain, or collapse. METHODS: In this observational, retrospective, study the sensitivity, specificity, and positive and negative predictive values of the Manchester Triage System were calculated using the triage classification for these patients, and their established diagnoses. The analysis included baseline characteristics and triage evaluations. RESULTS: During the two-year study period, 7055 patients were enrolled. Pulmonary embolism episodes were 2.1% of all cases, while severe pulmonary embolisms were 0.8%. The estimated specificity of the Manchester Triage System was 72.5% (CI 95%, 71.5-73.6), and the negative predictive value was 98.1% (CI 95%, 97.7-98.5). The results suggest that clinical characteristics leading to a high Manchester Triage System priority are similar to those characterising a pulmonary embolism episode. CONCLUSIONS: Although pulmonary embolism is difficult to diagnose, the Manchester Triage System is an effective tool for prioritising patients with symptoms of this disease.
Authors: Stefan Morreel; Hilde Philips; Diana De Graeve; Koenraad G Monsieurs; Jarl K Kampen; Jasmine Meysman; Eva Lefevre; Veronique Verhoeven Journal: PLoS One Date: 2021-11-03 Impact factor: 3.240