Abstract
BackgroundThe 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.MethodsConstruct 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.ResultsFor 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).ConclusionThe German version of the MTS is a reliable and valid instrument for a first assessment of emergency patients in the emergency department.
Highlights
Triage in the emergency department (ED) is defined as the process of quickly categorizing patients upon arrival to determine priority for further evaluation and care
There has been a trend toward centralization of emergency services in which previously decentralized out-patient clinics are integrated into a single interdisciplinary Emergency Department [5]
Application of the x2 test showed that there was a clear difference between Manchester Triage System (MTS) level and the proportion of patients admitted into hospital in general (p,0.0001 / x2 = 10149.27) and between hospitalization and the two levels normal ward or ICU (p,0.0001 / x2 = 17209.23)
Summary
There has been a trend toward centralization of emergency services in which previously decentralized out-patient clinics are integrated into a single interdisciplinary Emergency Department [5]. Along with this development, triage systems based on Anglo-American models are being established in German emergency rooms [6]. 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
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