Seiger Nienke, van Veen Mirjam, Almeida Helena, Steyerberg Ewout W, van Meurs Alfred H J, Carneiro Rita, Alves Claudio F, Maconochie Ian, van der Lei Johan, Moll Henriëtte A
Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Pediatrics, Hospital Fernando Fonseca, Amadora, Portugal.
PLoS One. 2014 Jan 15;9(1):e83267. doi: 10.1371/journal.pone.0083267. eCollection 2014.
This multicenter study examines the performance of the Manchester Triage System (MTS) after changing discriminators, and with the addition use of abnormal vital sign in patients presenting to pediatric emergency departments (EDs).
International multicenter study.
EDs of two hospitals in The Netherlands (2006-2009), one in Portugal (November-December 2010), and one in UK (June-November 2010).
Children (<16 years) triaged with the MTS who presented at the ED.
Changes to discriminators (MTS 1) and the value of including abnormal vital signs (MTS 2) were studied to test if this would decrease the number of incorrect assignment. Admission to hospital using the new MTS was compared with those in the original MTS. Likelihood ratios, diagnostic odds ratios (DORs), and c-statistics were calculated as measures for performance and compared with the original MTS. To calculate likelihood ratios and DORs, the MTS had to be dichotomized in low urgent and high urgent.
60,375 patients were included, of whom 13% were admitted. When MTS 1 was used, admission to hospital increased from 25% to 29% for MTS 'very urgent' patients and remained similar in lower MTS urgency levels. The diagnostic odds ratio improved from 4.8 (95%CI 4.5-5.1) to 6.2 (95%CI 5.9-6.6) and the c-statistic remained 0.74. MTS 2 did not improve the performance of the MTS.
MTS 1 performed slightly better than the original MTS. The use of vital signs (MTS 2) did not improve the MTS performance.
本多中心研究探讨了改变判别标准后，以及在儿科急诊科就诊患者中额外使用异常生命体征时，曼彻斯特分诊系统（MTS）的性能表现。
国际多中心研究。
荷兰两家医院的急诊科（2006 - 2009年）、葡萄牙一家医院的急诊科（2010年11月 - 12月）以及英国一家医院的急诊科（2010年6月 - 11月）。
在急诊科接受MTS分诊的16岁以下儿童。
研究判别标准的改变（MTS 1）以及纳入异常生命体征的价值（MTS 2），以检验这是否会减少错误分诊的数量。将使用新MTS的住院情况与原MTS的情况进行比较。计算似然比、诊断比值比（DORs）和c统计量作为性能指标，并与原MTS进行比较。为计算似然比和DORs，MTS必须分为低紧急和高紧急两类。
纳入60375例患者，其中13%入院。使用MTS 1时，“非常紧急”的MTS患者入院率从25%增至29%，较低MTS紧急程度水平的入院率保持相似。诊断比值比从4.8（95%CI 4.5 - 5.1）提高到6.2（95%CI 5.9 - 6.6），c统计量保持在0.74。MTS 2并未改善MTS的性能。
MTS 1的表现略优于原MTS。使用生命体征（MTS 2）并未改善MTS的性能。
