曼彻斯特分诊系统在成人医疗急诊患者中的应用：一项前瞻性队列研究。

Performance of the Manchester Triage System in Adult Medical Emergency Patients: A Prospective Cohort Study.

作者信息

Steiner Deborah, Renetseder Fabienne, Kutz Alexander, Haubitz Sebastian, Faessler Lukas, Anderson Janet Byron, Laukemann Svenja, Rast Anna Christina, Felder Susan, Conca Antoinette, Reutlinger Barbara, Batschwaroff Marcus, Tobias Petra, Buergi Ulrich, Mueller Beat, Schuetz Philipp

机构信息

University Department of Internal Medicine, Medical Faculty of the University of Basel, Kantonsspital Aarau, Aarau, Switzerland.

University Clinic of Infectious Diseases, University Hospital Bern, Bern, Switzerland.

出版信息

J Emerg Med. 2016 Apr;50(4):678-89. doi: 10.1016/j.jemermed.2015.09.008. Epub 2015 Oct 14.

DOI:10.1016/j.jemermed.2015.09.008

PMID:26458788

Abstract

BACKGROUND

Accurate initial patient triage in the emergency department (ED) is pivotal in reducing time to effective treatment by the medical team and in expediting patient flow. The Manchester Triage System (MTS) is widely implemented for this purpose. Yet the overall effectiveness of its performance remains unclear.

OBJECTIVES

We investigated the ability of MTS to accurately assess high treatment priority and to predict adverse clinical outcomes in a large unselected population of medical ED patients.

METHODS

We prospectively followed consecutive medical patients seeking ED care for 30 days. Triage nurses implemented MTS upon arrival of patients admitted to the ED. The primary endpoint was high initial treatment priority adjudicated by two independent physicians. Secondary endpoints were 30-day all-cause mortality, admission to the intensive care unit (ICU), and length of stay. We used regression models with area under the receiver operating characteristic curve (AUC) as a measure of discrimination.

RESULTS

Of the 2407 patients, 524 (21.8%) included patients (60.5 years, 55.7% males) who were classified as high treatment priority; 3.9% (n = 93) were transferred to the ICU; and 5.7% (n = 136) died. The initial MTS showed fair prognostic accuracy in predicting treatment priority (AUC 0.71) and ICU admission (AUC 0.68), but not in predicting mortality (AUC 0.55). Results were robust across most predefined subgroups, including patients diagnosed with infections, or cardiovascular or gastrointestinal diseases. In the subgroup of neurological symptoms and disorders, the MTS showed the best performance.

CONCLUSION

The MTS showed fair performance in predicting high treatment priority and adverse clinical outcomes across different medical ED patient populations. Future research should focus on further refinement of the MTS so that its performance can be improved.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT01768494.

摘要

背景

急诊科准确的初始患者分诊对于缩短医疗团队进行有效治疗的时间以及加快患者流转至关重要。为此，曼彻斯特分诊系统（MTS）被广泛应用。然而，其整体表现的有效性仍不明确。

目的

我们调查了MTS在大量未经筛选的急诊科内科患者中准确评估高治疗优先级以及预测不良临床结局的能力。

方法

我们对连续就诊于急诊科的内科患者进行了30天的前瞻性随访。分诊护士在患者进入急诊科时应用MTS。主要终点是由两名独立医生判定的高初始治疗优先级。次要终点是30天全因死亡率、入住重症监护病房（ICU）以及住院时间。我们使用以受试者操作特征曲线下面积（AUC）作为判别指标的回归模型。

结果

在2407例患者中，524例（21.8%）被归类为高治疗优先级（年龄60.5岁，男性占55.7%）；3.9%（n = 93）被转入ICU；5.7%（n = 136）死亡。初始MTS在预测治疗优先级（AUC 0.71）和ICU入住（AUC 0.68）方面显示出尚可的预后准确性，但在预测死亡率方面（AUC 0.55）则不然。在大多数预定义亚组中结果都很稳健，包括诊断为感染、心血管疾病或胃肠道疾病的患者。在神经症状和疾病亚组中，MTS表现最佳。