Manchester Triage System Research Articles

Do patients referred to emergency departments after being assessed in primary care differ from other ED patients? Retrospective analysis of a random sample from two German metropolitan EDs

BackgroundTo assess differences between patients referred to emergency departments by a primary care physician (PCP) and those presenting directly and the impact of referral on the likelihood of admission.Design of studyRetrospective cohort study.SettingEDs of two nonacademic general hospitals in a German metropolitan region.ParticipantsRandom sample of 1500 patients out of 80,845 presentations during the year 2019.ResultsAge was 55.8 ± 22.9 years, and 51.4% was female. A total of 34.7% presented by emergency medical services (EMS), and 47.7% were walk-ins. One-hundred seventy-four (11.9%) patients were referred by PCPs. Referrals were older (62.4 ± 20.1 vs 55.0 ± 23.1 years, p < .001) and had a higher Charlson Comorbidity Index (CCI) (3 (1–5) vs 2 (0–4); p < .001). Referrals received more ultrasound examinations independently from their admission status (27.6% vs 15.7%; p < .001) and more CT and laboratory investigations. There were no differences in sex, Manchester Triage System (MTS) category, or pain-scale values. Referrals presented by EMS less often (9.2% vs 38.5%; p < .001). Admission rates were 62.6% in referrals and 37.1% in non-referrals (p < .001). Referral (OR 3.976 95% CI: 2.595–6.091), parenteral medication in ED (OR 2.674 (1.976–3.619)), higher MTS category (1.725 (1.421–2.093)), transport by EMS (1.623 (1.212–2.172)), abnormal vital parameters (1.367 (0.953–1.960)), higher CCI (1.268 (1.196–1.344)), and trauma (1.268 (1.196–1.344)) were positively associated with admission in multivariable analysis, whereas ultrasound in ED (0.450 (0.308–0.658)) and being a nursing home resident (0.444 (0.270–0.728)) were negatively associated.ConclusionReferred patients were more often admitted. They received more laboratory investigations, ultrasound examinations, and computed tomographies. Difficult decisions regarding the necessity of admission requiring typical resources of EDs may be a reason for PCP referrals.

Using emergency department triage for machine learning-based admission and mortality prediction.

Patient admission is a decision relying on sparsely available data. This study aims to provide prediction models for discharge versus admission for ward observation or intensive care, and 30 day-mortality for patients triaged with the Manchester Triage System. This is a single-centre, observational, retrospective cohort study from data within ten minutes of patient presentation at the interdisciplinary emergency department of the Kepler University Hospital, Linz, Austria. We trained machine learning models including Random Forests and Neural Networks individually to predict discharge versus ward observation or intensive care admission, and 30 day-mortality. For analysis of the features' relevance, we used permutation feature importance. A total of 58323 adult patients between 1 December 2015 and 31 August 2020 were included. Neural Networks and Random Forests predicted admission to ward observation with an AUC-ROC of 0.842 ± 0.00 with the most important features being age and chief complaint. For admission to intensive care, the models had an AUC-ROC of 0.819 ± 0.002 with the most important features being the Manchester Triage category and heart rate, and for the outcome 30 day-mortality an AUC-ROC of 0.925 ± 0.001. The most important features for the prediction of 30 day-mortality were age and general ward admission. Machine learning can provide prediction on discharge versus admission to general wards and intensive care and inform about risk on 30 day-mortality for patients in the emergency department.

Impact of the junior doctors' industrial action on the emergency eye department in a large tertiary ophthalmic hospital: the Manchester experience.

To assess the impact of the junior doctors' industrial action on one of the largest emergency eye departments (EED) in the United Kingdom. We compared staff allocation, patient presentation, time in streaming, time in the department, the Manchester Triage System (MTS) score, number of eye emergencies and follow-up care of patients who attended the EED in the Manchester Royal Eye Hospital (MREH) during the 3-day industrial action (13-15 March 2023) compared with control periods 2weeks before and 2weeks after the industrial action. During the industrial action, there were almost 1.5 times more staff allocated to EED with a near doubling of the senior workforce. There was no difference in patient presentation, MTS score, number of eye emergencies or patient follow-up during the industrial action. However, patients had significantly less time in streaming (p < 0.001) and in the department (p < 0.001) during the industrial action compared to control periods. Emergency ophthalmic patient care was not compromised during the industrial action due to the reallocation of the workforce to EED. The results of this study may help in the planning of ophthalmic eye-care services in the event of future industrial actions.

Italian validation of the Manchester Triage System towards short-term mortality: a prospective observational study

The study aimed to validate the Manchester Triage System in a hospital setting using data for short- and medium-term death rates. A prospective observational study was conducted at the Emergency Department of Merano Hospital for two years. The discriminatory ability of MTS was tested using AUROCs and contingency tables, reporting sensitivity and specificity levels for each study outcome. A total of 98,443 patients were enrolled, 237 of whom died within 72h; 422 patients died within seven days, and 1025 died within 30 days. The MTS demonstrated excellent discriminatory ability, reporting AUROC values of 0.890 for death within 72h, 0.853 for death within seven days, and 0.781 for death within 30 days. A sensitivity of 87.7% and a specificity of 79.4% were reported for death at 72h, while a sensitivity of 69.6% and a specificity of 79.8% were reported for death at 30 days. The MTS has proven to be a good triage system capable of accurately identifying patients who are at risk of death in the short or medium term.

Use of emergency primary care among pregnant undocumented migrants over ten years: an observational study from Oslo, Norway

Objective To compare consultations with pregnant undocumented migrants at emergency primary health care to consultations with pregnant residents of Norway. Design A cross-sectional study of consultations at several time points. Setting The study was conducted at the Oslo Accident and Emergency Outpatient Clinic (OAEOC), the main emergency primary care service in Oslo, Norway. Subjects Consultations with pregnant patients without a Norwegian identity number seeking care at the Department of Emergency General Practice at the OAEOC were identified through a manual search of registration lists from 2009 to 2019. The consultations were categorized by women’s residency status as ‘probably documented migrant’, ‘uncertain migrant status’, or ‘probably undocumented migrant’. We also extracted aggregated data for women with a Norwegian identity number (i.e. residents) presenting in consultations with pregnancy-related (ICPC-2 chapter W) conditions. Main outcome measures Manchester Triage System urgency level at presentation, and hospitalization. Results Among 829 consultations with female patients categorized as probably undocumented migrants, we found 27.1% (225/829) with pregnant women. About half of the pregnant women (54.6% (123/225)) presented with a pregnancy-related condition. Pregnant women that were probably undocumented migrants had an increased risk of being triaged with a high level of urgency at presentation (relative risk (RR) 1.86, 95% CI 1.14–3.04) and being hospitalized (RR 1.68, 95% CI 1.21–2.34), compared to pregnant residents. Conclusion Pregnant undocumented migrants were more severely sick when presenting to emergency primary care services than pregnant residents. Increased access to primary care and emergency primary care services for pregnant undocumented migrants is urgently needed.

Comparison between local and three validated triage systems in an emergency department for 2126 children under 3 months.

Triage of patients less than 3 months old was not already studied. The aim was to evaluate Paediatric Emergency Department triage in patients less than 3 months old and newborns using a local system in comparison with three validated paediatric triage systems (Canadian Triage and Acuity Scale, Manchester Triage System and Emergency Severity Index) and to determine inter-system agreement. All admissions of patients less than 3 months old admitted to the Emergency Department of the Saint Vincent University Hospital between April 2018 and December 2019 were included. The local triage system level was determined prospectively for comparison with retrospectively calculated triage levels of the validated systems. Hospitalisation rates were compared and inter-system agreements determined. Among emergency admissions, 2126 were included (55% males, mean age 45 days). Hospitalisation rate increased with priority severity as determined by all triage systems studied. Cohen's kappa showed slight agreement between the local triage system and the Canadian Triage and Acuity Scale, Emergency Severity Index and Manchester Triage System (weighted kappa = 0.133, 0.185 and 0.157 respectively). Whether prospective or retrospective triage used, the systems studied exhibited good association with hospitalisation rate for patients aged less than 3 months and newborn infants.

Validity of the Manchester triage system in the prioritization of patients with transient global amnesia in the emergency department

AbstractBackgroundThe Manchester Triage System (MTS) is one of the most widely used and studied triage systems in emergency departments (ED). MTS does not have a specific presentational flow chart for patients with transient global amnesia (TGA). The goal of this study was to determine the adequacy of priority code assignment for patients with TGA presenting at the ED and triaged using the MTS.MethodsThis is a single‐center observational retrospective study from January 01, 2013 to June 31, 2020. All patients with a medical diagnosis of TGA were considered. An audit was conducted on these triages to assess the correct application of MTS by the triage nurses. Correct triage was considered as a patient classified as yellow.ResultsDuring the study period, 216 patients with a diagnosis of TGA were considered. Of these 49.5% were classified as yellow, 13.0% were undertriage and classified as green or blue and 37.5% were overtriaged and classified as orange or red. The audit demonstrated that 98.8% of overtriaged patients and 57.1% of undertriage patients were triaged incorrectly. In addition, in 38 patients the triage nurse confused TGA with an acute neurological deficit suggestive of stroke or transient ischemic attack.ConclusionThe present study demonstrates an inability of MTS to correctly stratify patients with TGA. The results of the present study indicate the need for a specific flow chart for patients with neurological problems to improve the performance of MTS.

Study about the Manchester Triage System subtriage in patients that visited the Emergency Department due to headache

IntroductionHeadache is a frequent cause of consultation; it is important to detect patients with secondary headache, particularly high-risk secondary headache. Such systems as the Manchester Triage System (MTS) are used for this purpose. This study aims to evaluate the frequency of undertriage in patients attending the emergency department due to headache. Material and methodsWe studied a series of consecutive patients who came to the emergency department with headache and presenting some warning sign, defined as the presence of signs leading the physician to request an emergency neuroimaging study and/or assessment by the on-call neurologist. The reference diagnosis was established by neurologists. We evaluated the MTS triage level assigned and the presence of warning signs that may imply a higher level than that assigned. ResultsWe registered a total of 1120 emergency department visits due to headache, and 248 patients (22.8%) were eligible for study inclusion. Secondary headache was diagnosed in 126 cases (50.8% of the sample; 11.2% of the total), with 60 cases presenting high-risk secondary headache (24.2%; 5.4%). According to the MTS, 2 patients were classified as immediate (0.8%), 26 as very urgent (10.5%), 147 as urgent (59.3%), 68 as normal (27.4%), and 5 as not urgent (2%). The percentage of patients undertriaged was 85.1% in the very urgent classification level and 23.3% in the urgent level. ConclusionDuring the study period, at least one in 10 patients attending the emergency department due to headache had secondary headache; one in 20 had high-risk secondary headache. The MTS undertriaged most patients with warning signs suggesting a potential emergency.

Evaluation of the Manchester Triage System in Patients with Acute Primary Angle Closure Attack: A Retrospective Study

Acute primary angle closure attack is an ophthalmological emergency. The aim of this study was to describe the cases diagnosed in the Emergency Department, by correlating the initial complaint with the Manchester triage level and ultimately the time needed until ophthalmological evaluation and iridotomy. Retrospective analysis of the electronic medical records of patients with acute primary angle closure attack that attended the Ophthalmology Emergency Department of our tertiary center between January 2010 and December 2020. Overall, 2228 Emergency Department episodes coded with the diagnoses glaucoma or ocular hypertension were retrieved, followed by screening of each episode for correct identification of true acute primary angle closure attacks. Clinical data was gathered, including Manchester triage level, presenting complaint, intraocular pressure at presentation, first medical specialty that observed the patient, time until observation by Ophthalmology and time until laser iridotomy. Among the 120 patients identified, 84 (70%) were female and the mean age was 68 ± 12 years. Mean intraocular pressure at admission was 53.4 ± 12.4 mmHg, and 9.2% of patients presented only non-ocular complaints, while 9.2% presented mixed complaints (ocular and non-ocular). Most patients (68.1%) with only non-ocular or mixed complaints were triaged to a non-ophthalmologist (p < 0.001). Concerning the triage system, at admission, most patients (66.7%) were labelled yellow (urgent), while 9.2% and none were labelled as orange (very urgent) or red (emergent), respectively. Most patients (83.3%) were directly sent to Ophthalmology (properly triaged), while the remaining were incorrectly assigned to a non-ophthalmologist. Median time until observation by Ophthalmology was 49 minutes in the properly triaged group (min. 15, max. 404), while it was 288 minutes (min. 45, max. 871) in those who were incorrectly triaged (p < 0.001). Likewise, median time until treatment with laser iridotomy was 203 minutes in the properly triaged group (min. 22, max. 1440) and 353 minutes in the incorrectly triaged group (min.112, max. 947) (p < 0.001). Most patients with acute primary angle closure attack were not properly triaged according to the level of the Manchester triage system. There was a significant delay in the diagnosis and treatment of those patients who were first assigned to non-ophthalmologists. There is a need to raise awareness regarding the presenting signs and symptoms of an acute primary angle closure attack in order to avoid preventable vision loss.

Assess the Risk Level of Acute Coronary Syndrome (ACS) Among Patients with Chest Pain in Emergency Department

Background: Fast and accurate chest pain risk stratification in the Emergency Department (ED) is critical. The HEART score predicts the short-term incidence of major cardiac events (MACE) in this population and divides them into three risk categories. Our aim was to describe the chest pain population, to characterize the subset of patients with acute coronary syndrome (ACS), and to assess the prognostic value of the Manchester triage system and the HEART score.Chest pain is a common symptom in all health care settings and may be due to a extensive variety of disease conditions. Some of those will be because of treatable causes, including musculoskeletal problems with favorable outcomes; others will be because of probably deadly life-threatening conditions, inclusive of acute coronary syndrome. Methods: Descriptive research design was adopted to conduct the study with( n=60) samples who met the inclusion criteria at Saveetha Medical College and Hospital. Samples were selected by convenience sampling Saveetha Medical College and Hospital, Chennai. A total of 60 Samples who met the inclusion criteria is selected by using convenience sampling technique. After selecting the sample, the investigator introduced him-self and explained the purpose of the study to the participants. Informed consent was obtained from the participants after assured confidentiality. The demographic and clinical variables were collected by using multiple choice questionnaires. Assess the risk level of acute coronary syndrome (ACS) by using HEART score immediately after receiving the chest pain patients with emergency. The data were collected, and score evaluation will take 10 -15 minutes after The data were tabulated and analyzed by descriptive and inferential statistics Result: The risk level of acute coronary syndrome (ACS) among patients with chest pain in emergency department. Study finding shows that out of 60 samples in risk level of acute coronary syndrome (ACS) among patients with chest pain in emergency department by using HEART Score 36(60%) had high risk, 13(21.7%) had intermediate risk and11(18.3%)had low risk. Conclusion: The chest pain is the most associate feature of major adverse cardiac events in the conditions. Chest pain is a common presentation at the Emergency Room. Rapid identification level of risk acute coronary syndrome (ACS)isacrucial component of thetriage. HEART Score is an efficient score in triaging acute chest pain patients at the Emergency Department

Door-to-furosemide time and clinical outcomes in acute heart failure.

Acute heart failure (AHF) is one of the main causes of unplanned hospitalization in patients >65 years of age and is associated with adverse outcomes in this population. Observational studies suggest that intravenous diuretic therapy given in the first hour of presentation for AHF was associated with favorable outcomes. To study the short-term prognostic associations of the timing of intravenous diuretic therapy in patients admitted to the emergency department (ED) for acute AHF. Patients treated in the ED with intravenous diuretics were selected from the Estratificação de Doentes com InsuFIciência Cardíaca Aguda (EDIFICA) registry, a prospective study including AHF hospitalized patients. Early and non-early furosemide treatment groups were considered using the 1-h cutoff: door-to-furosemide ≤1 h and >1 h. Primary outcomes were a composite of heart failure re-hospitalizations or cardiovascular death at 30- and 90-days. Four-hundred ninety-three patients were included in the analysis. The median (interquartile range) door-to-furosemide time was 85 (41-220) min, and 210 (43%) patients had diuretics in the first hour. Patients in the ≤1 h group had higher evaluation priority according to the Manchester Triage System, presented more often with acute pulmonary edema, warm-wet clinical profile, higher blood pressure, and signs of left-side heart failure, while >1 h group had higher Get With the Guidelines-heart failure risk score, more frequent signs of right-side heart failure, higher circulating B-type natriuretic peptides and lower albumin. Door-to-furosemide ≤ 1 h was independently associated with lower 30-day heart failure hospitalizations and composite of heart failure hospitalizations or cardiovascular death (adjusted analysis Heart Failure Hospitalizations: odds ratios (OR) 3.65; 95% confidence interval (CI), 1.22-10.9; P = 0.020; heart failure hospitalizations or cardiovascular death: OR 3.15; 95% CI, 1.49-6.64; P < 0.001). These independent associations lost significance at 90 days. Door-to-furosemide ≤1 h was associated with a lower short-term risk of heart failure hospitalizations or cardiovascular death in AHF patients. Our findings add to the existing evidence that early identification and intravenous diuretic therapy of AHF patients may improve outcomes.

Effect of the COVID-19 pandemic on the frequency of emergency department visits in Portugal: An interrupted time series analysis until July 2021.

This study aims to evaluate the effect of the COVID-19 pandemic on the frequency of emergency department (ED) visits in Portugal between March 2020 and July 2021. We used data on the monthly number of visits for all public hospitals' EDs from mainland Portugal between January 2017 and July 2021. We studied the impact of the pandemic overall, by type of ED (general, pediatric, and obstetric) and by Manchester Triage System color (red, orange, yellow, green, and blue) using an interrupted time series analysis. The prepandemic period corresponded to the months from January 2017 to February 2020 and the pandemic period to the months from March 2020 to July 2021. We observed over 26 million ED visits, the majority in general EDs (74.0%) and triaged yellow (48.4%) or green (38.4%). During the pandemic period, ED visits decreased 45.7% (95% confidence interval [CI]: -39.8% to -51.2%) and pediatric ED visits decreased by 72.4% (95% CI: -64.6% to -78.6%). A decrease was observed for all colors but tended to be progressively smaller as the priority increased. There was an increase in ED visits during the pandemic period (2.3%; 95% CI: 1.4% to 3.2%), eventually returning to prepandemic values. Our data indicate a considerable and long-lasting effect of the COVID-19 pandemic affecting mainly pediatric and milder cases, which were returning toward prepandemic values as the pandemic progressed. In a country with frequent use of EDs, the health system may need to be prepared to respond to prepandemic baseline ED demand, together with additional demand because of long-term sequels of COVID-19 cases and delayed care for chronic and acute conditions.

Pediatric emergency triage systems.

ABSTRACTObjective:The aim of this study was to perform a narrative review of the leading pediatric triage systems in emergency departments (EDs).Data source:Articles published between 1999 and 2019 were identified by searching the MEDLINE, EMBASE, and PubMed databases using the keywords “pediatric triage”, “pediatric assessment tools”, and “emergency department triage” with an emphasis on studies that evaluated the validation and reliability of triage systems.Data synthesis:A total of 105 articles on pediatric emergency triage systems in 12 countries were evaluated. Triage systems were divided into two groups: color-stratified triage systems and alert systems. The color-stratified triage systems included in this review were the Canadian Triage and Acuity Scale (CTAS), Manchester Triage System (MTS), Emergency Severity Index (ESI), and Australasian Triage Scale (ATS), and the alert systems included were the Paediatric Observation Priority Score (POPS), Pediatric Early Warning Score (PEWS), and Pediatric Approach Triangle (PAT). Evidence corroborates the validity and reliability of MTS, PaedCTAS, ESI version 4, PEWS, POPS, and PAT in pediatric emergency services.Conclusions:These are fundamental tools for risk classification of patients seeking treatment in EDs. Not all triage systems have been assessed for validity and reliability; nor are they well suited for all regions of the world. Employing triage systems in Brazil requires cultural adaptation and rigorous training of the local health staff, in addition to validation and reliability studies in our country, since the social and cultural context of this country differs from those where these tools were developed.

Audit of a computerized version of the Manchester triage system and a SIRS-based system for the detection of sepsis at triage in the emergency department

Background and importanceDifferent triage systems can be used to screen for sepsis and are often incorporated into local electronic health records. Often the design and interface of these digitalizations are not audited, possibly leading to deleterious effects on screening test performance.ObjectiveTo audit a digital version of the MTS for detection of sepsis during triage in the ED.DesignA single-center retrospective studySettings and participantsPatients (n=29766) presenting to an ED of a tertiary-care center who received formal triage were included.Outcome measures and analysisCalculated performance measures included sensitivity, specificity, likelihood ratios, and AUC for the detection of sepsis. Errors in the application of the specific sepsis discriminator of the MTS were recorded.Main resultsA total of 189 (0.7%) subjects met the Sepsis-3 criteria, with 47 cases meeting the criteria for septic shock. The MTS had a low sensitivity of 47.6% (95% CI 40.3 to 55.0) for allocating sepsis patients to the correct triage category. However, specificity was high at 99.4% (95% CI 99.3 to 99.5).

353 FACTORS ASSOCIATED WITH ADVERSE OUTCOMES IN OLDER ADULTS DIRECTLY DISCHARGED FROM THE EMERGENCY DEPARTMENT

Abstract Background Older adults attend the Emergency Department (ED) frequently. Over 40% are directly discharged from the ED. The risk of adverse outcomes is high following discharge including unplanned ED return, institutionalisation, and mortality. The purpose of this study was to highlight factors that predict these adverse outcomes. Methods A secondary analysis was completed of SOAED (a prospective cohort study examining screening instruments to predict adverse outcomes for undifferentiated older adults attending the ED) and OPTIMEND (randomised control trial examining the effectiveness of an intervention by a team of Health and Social Care Professionals along with usual care and compared this to standard ED care alone). Inclusion criteria were adults aged 65 years and over presenting to ED at a University Teaching Hospital with medical complaints and a Manchester Triage System category 2–5. Results Three-hundred and nine patients were discharged directly from ED (mean age 80 years; 58% female). 96 patients re-attended ED within 6 months. 66 patients were re-hospitalised within 6 months. 16 patients died within six months of discharge. 63% of the discharged patients screened positive for frailty measured by PRISMA-7 (3 or more). Relative risk ratio analysis confirmed that the risk of revisiting a hospital was 1.241 times for patients that scored frail compared to those who scored not frail. The risk of mortality was 1.075 times for patients that scored frail compared to those who scored not frail. The risk of being admitted to a nursing home was 1.146 times for patients that scored frail compared to those who scored not frail. Conclusion Older people have a high ED re-attendance rate of 31% after an index visit. Frailty (scored on PRISMA-7) is a significant predictor of adverse outcomes. Focused screening and intervention for frail patients who attend the ED should be a priority.

Improving the safety of the Manchester triage system for children with congenital heart disease

This study is a prospective evaluation of the validity of a Manchester triage system (MTS) modification for detecting under-triaged pediatric patients with congenital heart disease (CHD). Children with CHD visiting the emergency unit of the Department of Pediatrics and Adolescent Medicine, University Hospital Vienna in 2014 were included. The MTS modification updated the prioritization of patients with complex syndromic diseases, specific symptoms related to chronic diseases, decreased general condition (DGC), profound language impairment, unknown medical history, or special needs. A four-level outcome severity index based on diagnostic and therapeutic interventions, admission to hospital, and follow-up strategies was defined as a reference standard for the correct clinical classification of the MTS urgency level. Of the 19,264 included children, 940 had CHD. Of this group, 266 fulfilled the inclusion criteria for the modified triage method. The MTS modification was significantly more often applied in under-triaged (65.9%) than correctly or over-triaged (25%) children with CHD (p-value χ2 test < 0.0001, OR 5.848, 95% CI: 3.636–9.6).Conclusion: The MTS urgency level upgrade modification could reduce under-triage in children with CHD. Applying a safety strategy concept to the MTS could mitigate under-triage in such a high-risk patient group.What is Known:• The Manchester triage system is considered to be valid and reliable but tends to over-triage.• A study by Seiger et al. showed poor performance in children with chronic illnesses, especially in children with cardiovascular diseases.What is New:• The MTS modification with one urgency level upgrade could decrease under-triage in children with congenital heart disease.• As reference standard a four level outcome severity index (OSI) was established to include diagnostic investigations, medical interventions, hospital admission or follow up visits in the assessment.

Sensitivity of the SNNOOP10 list in the high-risk secondary headache detection.

To evaluate the diagnostic accuracy of the SNNOOP10 list in the detection of high-risk headaches. Patients that visited the Hospital Clínico San Carlos (Madrid) emergency department due to headache that were allocated to a Manchester Triage System level between critical and urgent were prospectively included but retrospectively analysed. A researcher blind to the patients' diagnosis administered a standardised questionnaire and afterwards a neurologist blind to the questionnaire results diagnosed the patient according to the International Classification of Headache Disorders. The primary endpoint was to assess the sensitivity of the SNNOOP10 list in the detection of high-risk headaches. Secondary endpoints included the evaluation of the sensitivity, specificity, positive predictive value, negative predictive value and area under the curve of each SNNOOP10 item. Between April 2015 and October 2021, 100 patients were included. Patients were 44 years old (inter-quartile range: 33.6-64.7) and 57% were female. We identified 37 different diagnoses. Final diagnosis was a primary headache in 33%, secondary headache in 65% and cranial neuralgia in 2%. There were 46 patients that were considered as having high-risk headache. Patients from the primary headache group were younger and more frequently female. Sensitivity of SNNOOP10 list was 100% (95% confidence interval: 90.2%-100%). The items with higher sensitivity were neurologic deficit or disfunction (75.5%), pattern change or recent onset of the headache (64.4%), onset after 50 years (64.4%). The most specific items were posttraumatic onset of headache (94.5%), neoplasm in history (89.1%) and systemic symptoms (89%). The area under the curve of the SNNOOP10 list was 0.66 (95% CI: 0.55-0.76). The red flags from the SNNOOP10 list showed a 100% sensitivity in the detection of high-risk headache disorders.

Differences in emergency nurse triage between a simulated setting and the real world, post hoc analysis of a cluster randomised trial

ObjectivesIn the TRIAGE trial, a cluster randomised trial about diverting emergency department (ED) patients to a general practice cooperative (GPC) using a new extension to the Manchester Triage System, the...

Identification through the Manchester Triage System of the older population at risk of delirium: A case-control study.

To identify the flow charts and discriminators of the Manchester Triage System that are most likely to identify the onset of delirium in older people. Delirium is an underdiagnosed geriatric syndrome, and up to 80% of all cases of delirium go undetected in emergency departments. Patient triage seeks to manage clinical risk with a view to safely and appropriately managing patient flows. A case-control study was performed according to the STROBE checklist. The emergency department of a secondary hospital. Older adults aged ≥65years and admitted from 1January to 31 December 2020. Older patients were identified from the emergency department research database. Cases were defined as patients diagnosed with delirium (n=128), excluding cases of delirium due to alcohol or substance abuse. Controls were randomised from the remaining patients (n=128). A total of 29.35% of the subjects admitted to the emergency department were older adults with an incidence of delirium of 0.7%. The flow charts with the highest probability of delirium were 'unwell adult' [OR=3.04 (95%CI:1.82-5.1)] and 'behaving strangely' [OR=16.06 (95%CI:3.72-69.29)], and the discriminators were 'rapid onset' [OR=3.3 (95%CI:1.85-5.88)] and 'new neurological deficit less than 24h old' [OR=4.76 (95%%CI:1.01-22.5). The area under the curve for 'unwell adult' in the presence of dementia, previous stroke and fall in the previous 30days was 0.73 (95%CI: 0.67-0.79), and that for 'behaving strangely' in the presence of diabetes was 0.75 (95%CI: 0.69-0.81). Knowing which flow charts, discriminators and risk factors are most likely to predict delirium allows the identification of the older population at risk for triage screening in emergency departments. Risk factors such as diabetes, dementia, previous stroke and recent fall among 'unwell adult' or 'behaving strangely' triaged older persons should be assessed for the probable presence of delirium.

Sensitivity and Specificity of Spanish Prehospital Advanced Triage Method (META).

Mass-casualty incident (MCI) triage systems aim to provide the best possible health care to the greatest number of affected people with the available resources in the context of a mass-casualty event. The Spanish Prehospital Advanced Triage Method (Modelo Extrahospitalario de Triaje Avanzado; META) was designed to improved patient sorting in MCIs. The aim of this study was to estimate and compare sensitivity and specificity of META and the Manchester Triage System (MTS) in MCIs by retrospectively applying both triage algorithms to real MCI patients from the Emergency and Disaster Research Unit (Unidad de Investigación en Emergencia y Desastres; UIED) MCI database. This was a comparative study of two triage methods using sensitivity and specificity with the Revised Trauma Score (RTS) as the gold standard. A total of 134 MCI patients from the UIED database were included. An MCI in Asturias is defined as an incident that involves four or more victims that require ambulance mobilization. Patients mean age was 39.85 years (95% CI, 35.9-43.8) with an age range from one to 88 years old. In total, 54.4% of the patients were female. The most common types of MCI involved were fires (51.0%), followed by road traffic accident (43.3%) and street fight (3.7%). For MTS, the overall sensitivity was 30.6% (95% CI, 22.9-39.1) and specificity was 66.0% (95% CI, 60.0-71.7). For META triage algorithm, the overall sensitivity was 79.9% (95% CI, 72.1-86.3) and specificity was 89.9% (95% CI, 85.7-93.3). The META triage algorithm is a reliable triage system; thus, it can be recommended to be used in an MCI.