Zachariasse Joany M, Kuiper Jan Willem, de Hoog Matthijs, Moll Henriëtte A, van Veen Mirjam
Department of General Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Pediatric Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
J Pediatr. 2016 Oct;177:232-237.e1. doi: 10.1016/j.jpeds.2016.06.068. Epub 2016 Jul 29.
To assess the safety of the Manchester Triage System in pediatric emergency care for children who require admission to the intensive care unit (ICU).
Between 2006 and 2013, 50 062 consecutive emergency department visits of children younger than the age of 16 years were included. We determined the percentage of undertriage, defined as the proportion of children admitted to ICU triaged as low urgent according to the Manchester Triage System, and diagnostic performance measures, including sensitivity, specificity, and diagnostic OR. Characteristics of undertriaged patients were compared with correctly triaged patients. In a logistic regression model, risk factors for undertriage were determined.
In total, 238 (28.7%) of the 830 children admitted to ICU during the study period were undertriaged. Sensitivity of high Manchester Triage System urgency levels to detect ICU admission was 71% (95% CI 68%-74%) and specificity 85% (95% CI 85%-85%). Severity of illness was lower in undertriaged children than correctly triaged children admitted to ICU. Risk factors for undertriage were age <3 months, medical presenting problem, comorbidity, referral by a medical specialist or emergency medical services, and presentation during the evening or night shift.
The Manchester Triage System misclassifies a substantial number of children who require ICU admission. Modifications targeted at young children and children with a comorbid condition could possibly improve safety of the Manchester Triage System in pediatric emergency care.
评估曼彻斯特分诊系统在需要入住重症监护病房（ICU）的儿科急诊护理中的安全性。
纳入2006年至2013年间16岁以下儿童连续50062次急诊就诊情况。我们确定了分诊不足的百分比，分诊不足定义为根据曼彻斯特分诊系统被分诊为低紧急程度但入住ICU的儿童比例，以及诊断性能指标，包括敏感性、特异性和诊断比值比。将分诊不足患者的特征与正确分诊患者进行比较。在逻辑回归模型中确定分诊不足的危险因素。
在研究期间入住ICU的830名儿童中，共有238名（28.7%）被分诊不足。曼彻斯特分诊系统高紧急程度水平检测ICU入住的敏感性为71%（95%CI 68%-74%），特异性为85%（95%CI 85%-85%）。分诊不足的儿童比入住ICU的正确分诊儿童病情严重程度更低。分诊不足的危险因素包括年龄小于3个月、就诊的医疗问题、合并症、由医学专家或紧急医疗服务机构转诊以及在晚班或夜班就诊。
曼彻斯特分诊系统将大量需要入住ICU的儿童分类错误。针对幼儿和患有合并症的儿童进行改进可能会提高曼彻斯特分诊系统在儿科急诊护理中的安全性。
