Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy.
College of Health Care Professions Claudiana, Bolzano-Bozen, Italy; Institute of Nursing Science, Department of Public Health, University of Basel, Switzerland.
J Crit Care. 2020 Oct;59:63-69. doi: 10.1016/j.jcrc.2020.05.019. Epub 2020 Jun 6.
Up to 15% of patients arrive in the emergency department suffering from fever. Triage is their first contact and is responsible for the stratification of patients according to the severity of the condition for which they are presenting at the emergency department. The aim of this study is to assess the predictive validity of the Manchester Triage System in patients with fever for sepsis or septic shock and seven-day mortality.
The sensitivity, specificity and negative predictive value of the Manchester Triage System was assessed by priority code allocation towards seven-day mortality and the diagnosis of sepsis or septic shock.
A total of 3831 patients were evaluated in the emergency department for fever between 1 January 2017 and 30 June 2019. Of these, 1.9% were diagnosed with sepsis or septic shock. Using the Manchester Triage System to predict diagnosis of sepsis or septic shock provided a sensitivity of 88.7%, a specificity of 50.1% and a negative predictive value of 99.5%. For seven-day mortality, sensitivity was 44.4%, specificity was 92.3% and the negative predictive value was 99.3%.
The Manchester Triage System has demonstrated high sensitivity and negative predictive value in patients with fever diagnosed with sepsis or septic shock. For patients with sepsis or septic shock one-third of cases with an incorrectly assigned priority code were caused by incorrect application of the Manchester Triage System.
多达 15%的患者在急诊科就诊时出现发热。分诊是他们的首次接触，负责根据患者在急诊科就诊的病情严重程度对患者进行分层。本研究旨在评估曼彻斯特分诊系统对发热患者发生脓毒症或脓毒性休克和 7 天死亡率的预测准确性。
通过优先级编码分配评估曼彻斯特分诊系统对 7 天死亡率和脓毒症或脓毒性休克诊断的敏感性、特异性和阴性预测值。
2017 年 1 月 1 日至 2019 年 6 月 30 日，共有 3831 名发热患者在急诊科接受评估。其中，1.9%被诊断为脓毒症或脓毒性休克。使用曼彻斯特分诊系统预测脓毒症或脓毒性休克的诊断，其敏感性为 88.7%，特异性为 50.1%，阴性预测值为 99.5%。对于 7 天死亡率，敏感性为 44.4%，特异性为 92.3%，阴性预测值为 99.3%。
曼彻斯特分诊系统在发热患者中诊断为脓毒症或脓毒性休克时具有较高的敏感性和阴性预测值。对于脓毒症或脓毒性休克患者，三分之一优先级编码分配错误的病例是由于曼彻斯特分诊系统的错误应用所致。
