The Manchester Triage System in paediatric emergency care

In the first part of the thesis performance of the Manchester Triage System in paediatric emergency care was evaluated. In chapter 1 we reviewed the literature to evaluate realibility and validity of triage systems in paediatric emergency care. The Manchester Triage System was used to triage patients when presenting at the emergency department of a general teaching hospital and the emergency department of a university paediatric hospital. The system’s reliability was evaluated in chapter 2. Its validity and specific patients groups for which validity was not optimal were discussed in chapter 3. Chapter 4 evaluates patient problems for which the MTS performs severe under-triage. The second part focuses on improvements of the MTS. Chapter 5 focuses on the value of temperature as discriminator in triage systems. The MTS was modified for patient groups with a low validity and the effect of the modification on the reliability and validity are studied in chapter 6. In the third part of this thesis we assess the ability of the MTS to safely identify low urgent patients. In chapter 7 determinants of hospitalisation for low urgent patients were evaluated. Chapter 8 reports about compliance and effect on costs when low urgent children, when presenting to the ED are referred to the general practitioner cooperative. Chapter 9 provides a summary of the findings and the future prospects.

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