Undertriage in the Manchester triage system: an assessment of severity and options for improvement
| Autor: | Henriëtte A. Moll, Ewout W. Steyerberg, A H J van Meurs, Madelon Ruige, M van Veen, Nienke Seiger |
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| Přispěvatelé: | Pediatrics, Public Health |
| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Pediatrics Adolescent Child Health Services Vital signs Blood Pressure Logistic regression Severity of Illness Index Respiratory Rate Heart Rate Severity of illness medicine Humans Prospective Studies Child Prospective cohort study Netherlands business.industry Patient Selection Infant Newborn Health services research Infant Emergency department Triage Hospitalization Child Preschool Pediatrics Perinatology and Child Health Emergency medicine Health Resources Female Observational study Health Services Research Emergencies Emergency Service Hospital business |
| Zdroj: | Archives of Disease in Childhood, 96(7), 653-657. BMJ Publishing Group |
| ISSN: | 1468-2044 0003-9888 |
| Popis: | Background The Manchester Triage System (MTS) determines an inappropriately low level of urgency (undertriage) to a minority of children. The aim of the study was to assess the clinical severity of undertriaged patients in the MTS and to define the determinants of undertriage. Methods Patients who had attended the emergency department (ED) were triaged according to the MTS. Undertriage was defined as a 'low urgent' classification (levels 3, 4 and 5) under the MTS; as a 'high urgent' classification (levels 1 and 2) under an independent reference standard based on abnormal vital signs (level 1), potentially life-threatening conditions (level 2), and a combination of resource use, hospitalisation, and follow-up for the three lowest urgency levels. In an expert meeting, three experienced paediatricians used a standardised format to determine the clinical severity. The clinical severity had been expressed by possible consequences of treatment delay caused by undertriage, such as the use of more interventions and diagnostics, longer hospitalisation, complications, morbidity, and mortality. In a prospective observational study we used logistic regression analysis to assess predictors for undertriage. Results In total, 0.9% (119/13,408) of the patients were undertriaged. In 53% (63/119) of these patients, experts considered undertriage as clinically severe. In 89% (56/63) of these patients the high reference urgency was determined on the basis of abnormal vital signs. The prospective observational study showed undertriage was more likely in infants (especially those younger than three months), and in children assigned to the MTS 'unwell child' flowchart (adjusted OR( |
| Databáze: | OpenAIRE |
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