Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Emerg Med J. 2012 Aug;29(8):654-9. doi: 10.1136/emermed-2011-200562. Epub 2012 Feb 14.
To improve the Manchester Triage System (MTS) in paediatric emergency care.
The authors performed a prospective observational study at the emergency departments of a university and teaching hospital in The Netherlands and included children attending in 2007 and 2008. The authors developed and implemented specific age-dependent modifications for the MTS, based on patient groups where the system's performance was low. Nurses applied the modified system in 11,481 (84%) patients. The reference standard for urgency defined five levels based on a combination of vital signs at presentation, potentially life-threatening conditions, diagnostic resources, therapeutic interventions and follow-up. The reference standard for urgency was previously defined and available in 11,260/11,481 (96%) patients.
Compared with the original MTS specificity improved from 79% (95% CI 79% to 80%) to 87% (95% CI 86% to 87%) while sensitivity remained similar ((63%, 95% CI 59% to 66%) vs (64%, 95% CI 60% to 68%)). The diagnostic OR increased (4.1 vs 11).
Modifications of the MTS for paediatric emergency care resulted in an improved specificity while sensitivity remained unchanged. Further research should focus on the improvement of sensitivity.
改进儿科急救中的曼彻斯特分诊系统（MTS）。
作者在荷兰一所大学和教学医院的急诊科进行了一项前瞻性观察研究，纳入了 2007 年和 2008 年就诊的儿童。作者根据系统表现不佳的患者群体，为 MTS 制定并实施了特定的、基于年龄的修改方案。护士在 11481 名（84%）患者中应用了改良后的系统。紧急程度的参考标准基于就诊时的生命体征、潜在危及生命的情况、诊断资源、治疗干预措施和随访，结合这几个方面定义了五个级别。紧急程度的参考标准之前已经定义并可用于 11260/11481 名（96%）患者。
与原始 MTS 相比，特异性从 79%（95%CI 79%80%）提高至 87%（95%CI 86%87%），而敏感性保持相似（63%（95%CI 59%66%）vs 64%（95%CI 60%68%））。诊断比值比增加（4.1 比 11）。
对儿科急救中的 MTS 进行修改可提高特异性，而敏感性保持不变。进一步的研究应侧重于提高敏感性。
