Australian Institute of Tropical Health and Medicine, College of Public Health Medical and Veterinary Sciences, Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland, Australia.
Emergency and Acute Medicine (CVK, CCM), Charite Universitätsmedizin Berlin, Berlin, Germany.
BMJ Open. 2019 May 6;9(5):e024896. doi: 10.1136/bmjopen-2018-024896.
To investigate the suitability of the German version of the Manchester Triage System (MTS) as a potential tool to redirect emergency department (ED) patients to general practitioner care. Such tools are currently being discussed in the context of reorganisation of emergency care in Germany.
Prospective cohort study.
Single centre University Hospital Emergency Department.
Adult, non-surgical ED patients.
A non-urgent triage category was defined as a green or blue triage category according to the German version of the MTS.
Surrogate parameters for short-term risk (admission rate, diagnoses, length of hospital stay, admission to the intensive care unit, in-hospital and 30-day mortality) and long-term risk (1-year mortality).
A total of 1122 people presenting to the ED participated in the study. Of these, 31.9% (n=358) received a non-urgent triage category and 68.1% (n=764) were urgent. Compared with non-urgent ED presentations, those with an urgent triage category were older (median age 60 vs 56 years, p=0.001), were more likely to require hospital admission (47.8% vs 29.6%) and had higher in-hospital mortality (1.6% vs 0.8%). There was no significant difference observed between non-urgent and urgent triage categories for 30-day mortality (1.2% [n=4] vs 2.2% [n=15]; p=0.285) or for 1-year mortality (7.9% [n=26] vs 10.5% [n=72]; p=0.190). Urgency was not a significant predictor of 1-year mortality in univariate (HR=1.35; 95% CI 0.87 to 2.12; p=0.185) and multivariate regression analyses (HR=1.20; 95% CI 0.77 to 1.89; p=0.420).
The results of this study suggest the German MTS is unsuitable to safely identify patients for redirection to non-ED based GP care.
U1111-1119-7564; Post-results.
研究德国曼彻斯特分诊系统（MTS）版本是否适合作为将急诊患者转至全科医生护理的潜在工具。此类工具目前正在德国重新组织急诊护理的背景下进行讨论。
前瞻性队列研究。
单中心大学医院急诊科。
成年非手术急诊患者。
根据德国版 MTS，非紧急分诊类别定义为绿色或蓝色分诊类别。
短期风险（入院率、诊断、住院时间、入住重症监护病房、住院和 30 天死亡率）和长期风险（1 年死亡率）的替代参数。
共有 1122 名患者在急诊科接受了研究。其中，31.9%（n=358）被分诊为非紧急类别，68.1%（n=764）为紧急类别。与非紧急 ED 就诊相比，紧急分诊类别的患者年龄更大（中位数年龄 60 岁 vs 56 岁，p=0.001），更有可能需要住院治疗（47.8% vs 29.6%），住院死亡率更高（1.6% vs 0.8%）。在 30 天死亡率（1.2%[n=4] vs 2.2%[n=15]；p=0.285）或 1 年死亡率（7.9%[n=26] vs 10.5%[n=72]；p=0.190）方面，非紧急和紧急分诊类别之间无显著差异。在单变量（HR=1.35；95%CI 0.87 至 2.12；p=0.185）和多变量回归分析（HR=1.20；95%CI 0.77 至 1.89；p=0.420）中，紧急情况不是 1 年死亡率的显著预测因子。
本研究结果表明，德国 MTS 不适合安全识别患者，以便将其转至非急诊的基础 GP 护理。
U1111-1119-7564；事后注册。
