The Manchester triage system: improvements for paediatric emergency care

被引:31
作者
van Veen, Mirjam [1 ]
Steyerberg, Ewout W. [2 ]
van't Klooster, Mariet [1 ]
Ruige, Madelon [3 ]
van Meurs, Alfred H. J. [3 ]
van der Lei, Johan [4 ]
Moll, Henriette A. [1 ]
机构
[1] Erasmus MC Sophia Childrens Hosp, Dept Paediat, NL-3000 CB Rotterdam, Netherlands
[2] Erasmus MC, Ctr Med Decis Making, Rotterdam, Netherlands
[3] Juliana Childrens Hosp, Haga Hosp, Dept Paediat, The Hague, Netherlands
[4] Erasmus MC, Dept Med Informat, Rotterdam, Netherlands
关键词
OF-HOURS CARE; SEVERITY INDEX; ACUITY SCALE; FEBRILE CHILDREN; CANADIAN TRIAGE; RISK; VALIDATION; SIMULATION; VALIDITY; ILLNESS;
D O I
10.1136/emermed-2011-200562
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective To improve the Manchester Triage System (MTS) in paediatric emergency care. Methods The authors performed a prospective observational study at the emergency departments of a university and teaching hospital in The Netherlands and included children attending in 2007 and 2008. The authors developed and implemented specific age-dependent modifications for the MTS, based on patient groups where the system's performance was low. Nurses applied the modified system in 11 481 (84%) patients. The reference standard for urgency defined five levels based on a combination of vital signs at presentation, potentially life-threatening conditions, diagnostic resources, therapeutic interventions and follow-up. The reference standard for urgency was previously defined and available in 11 260/ 11 481 (96%) patients. Results Compared with the original MTS specificity improved from 79% (95% CI 79% to 80%) to 87% (95% CI 86% to 87%) while sensitivity remained similar ((63%, 95% CI 59% to 66%) vs (64%, 95% CI 60% to 68%)). The diagnostic OR increased (4.1 vs 11). Conclusions Modifications of the MTS for paediatric emergency care resulted in an improved specificity while sensitivity remained unchanged. Further research should focus on the improvement of sensitivity.
引用
收藏
页码:654 / 659
页数:6
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