Department of Emergency Medicine, Franz Tappeiner Hospital of Merano, Azienda Sanitaria dell'Alto Adige, Merano 39012 (BZ), Bolzano, Italy.
Department of Emergency Medicine, Franz Tappeiner Hospital of Merano, Azienda Sanitaria dell'Alto Adige, Merano 39012 (BZ), Bolzano, Italy.
Int Emerg Nurs. 2020 May;50:100842. doi: 10.1016/j.ienj.2020.100842. Epub 2020 Mar 20.
Recognising patients with pulmonary embolism continues to be a clinical challenge. In the Emergency Department, up to 50% of patients with pulmonary embolism can be delayed or even misdiagnosed. The ability of a triage system to correctly prioritise suspected embolism in these patients is fundamental for determining diagnostic-therapeutic procedures.
To verify the effectiveness of the Manchester Triage System in risk prioritisation of patients with pulmonary embolism who present with dyspnoea, chest pain, or collapse.
In this observational, retrospective, study the sensitivity, specificity, and positive and negative predictive values of the Manchester Triage System were calculated using the triage classification for these patients, and their established diagnoses. The analysis included baseline characteristics and triage evaluations.
During the two-year study period, 7055 patients were enrolled. Pulmonary embolism episodes were 2.1% of all cases, while severe pulmonary embolisms were 0.8%. The estimated specificity of the Manchester Triage System was 72.5% (CI 95%, 71.5-73.6), and the negative predictive value was 98.1% (CI 95%, 97.7-98.5). The results suggest that clinical characteristics leading to a high Manchester Triage System priority are similar to those characterising a pulmonary embolism episode.
Although pulmonary embolism is difficult to diagnose, the Manchester Triage System is an effective tool for prioritising patients with symptoms of this disease.
识别肺栓塞患者仍然是一个临床挑战。在急诊科，多达 50%的肺栓塞患者可能会被延迟诊断甚至误诊。分诊系统正确优先考虑这些患者疑似栓塞的能力对于确定诊断-治疗程序至关重要。
验证曼彻斯特分诊系统在对出现呼吸困难、胸痛或晕厥的疑似肺栓塞患者进行风险分层的有效性。
在这项观察性、回顾性研究中，使用这些患者的分诊分类及其既定诊断来计算曼彻斯特分诊系统的灵敏度、特异性以及阳性和阴性预测值。分析包括基线特征和分诊评估。
在两年的研究期间，共纳入了 7055 名患者。肺栓塞发作占所有病例的 2.1%，而严重肺栓塞占 0.8%。曼彻斯特分诊系统的估计特异性为 72.5%（95%CI，71.5-73.6），阴性预测值为 98.1%（95%CI，97.7-98.5）。结果表明，导致曼彻斯特分诊系统优先级较高的临床特征与肺栓塞发作的特征相似。
尽管肺栓塞难以诊断，但曼彻斯特分诊系统是一种用于优先考虑有这种疾病症状的患者的有效工具。
