Objective: To validate use of the Manchester triage system in paediatric emergency care. Design: Prospective observational study. Setting: Emergency departments of a university hospital and a teaching hospital in the Netherlands, 2006-7. Participants: 17 600 children (aged <16) visiting an emergency department over 13 months (university hospital) and seven months (teaching hospital). Intervention: Nurses triaged 16 735/17 600 patients (95%) using a computerised Manchester triage system, which calculated urgency levels from the selection of discriminators embedded in flowcharts for presenting problems. Nurses over-ruled the urgency level in 1714 (10%) children who were excluded from analysis. Complete data for the reference standard were unavailable in 1467 (9%) children, leaving 13 554 patients for analysis. Main outcome measures: Urgency according to the Manchester triage system compared with a predefined and independently assessed reference standard for five urgency levels. This reference standard was based on a combination of vital signs at presentation, potentially life threatening conditions, diagnostic resources, therapeutic interventions, and follow-up. Sensitivity, specificity, and likelihood ratios for high urgency (immediate and very urgent) and 95% confidence intervals for subgroups based on age, use of flowcharts, and discriminators. Results: The Manchester urgency level agreed with the reference standard in 4582 of 13 554 (34%) children; 7311 (54%) were over-triaged and 1661 (12%) undertriaged. The likelihood ratio was 3.0 (95% confidence interval 2.8 to 3.2) for high urgency and 0.5 (0.4 to 0.5) for low urgency; though the likelihood ratios were lower for those presenting with a medical problem (2.3 (2.2 to 2.5) v 12.0 (7.8 to 18.0) for trauma) and in younger children (2.4 (1.9 to 2.9) at 0-2 months v 5.4 (4.5 to 6.5) at 8-16 years). Conclusions: The Manchester triage system has moderate validity in paediatric emergency care. It errs on the safe side, with much more over-triage than under-triage compared with an independent reference standard for urgency. Triage of patients with a medical problem or in younger children is particularly difficult.

Additional Metadata
Keywords Adolescent, Child, Netherlands, United Kingdom, article, child care, controlled study, emergency health service, female, human, major clinical study, male, nursing care, outcome assessment, priority journal, sensitivity and specificity, standard
Persistent URL dx.doi.org/10.1136/bmj.a1501, hdl.handle.net/1765/14616
Citation
van Veen, M., Steyerberg, E.W., Ruige, M., van Meurs, A.H.J., Roukema, J., van der Lei, J., & Moll, H.A.. (2008). Manchester triage system in paediatric emergency care: Prospective observational study. BMJ : British medical journal / British Medical Association, 337, 792–795. doi:10.1136/bmj.a1501