Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy.
College of Health Care Professions Claudiana, Bolzano-Bozen, Italy.
J Clin Nurs. 2021 Apr;30(7-8):942-951. doi: 10.1111/jocn.15635. Epub 2021 Jan 25.
Roughly 5% to 10% of patients admitted to the emergency department suffer from acute abdominal pain. Triage plays a key role in patient stratification, identifying patients who need prompt treatment versus those who can safely wait. In this regard, the aim of this study was to estimate the performance of the Manchester Triage System in classifying patients with acute abdominal pain.
A total of 9,851 patients admitted at the Emergency Department of the Merano Hospital with acute abdominal pain were retrospectively enrolled between 1 January 2017 and 30 June 2019. The study was conducted and reported according to the STROBE statement. The sensitivity and specificity of the Manchester Triage System were estimated by verifying the triage classification received by the patients and their survival at seven days or the need for acute surgery within 72 h after emergency department access.
Among the patients with acute abdominal pain (median age 50 years), 0.4% died within seven days and 8.9% required surgery within 72 hours. The sensitivity was 44.7% (29.9-61.5), specificity was 95.4% (94.9-95.8), and negative predictive value was 99.7% (99.2-100) in relation to death at seven days.
The Manchester Triage System shows good specificity and negative predictive value. However, its sensitivity was low due to the amount of incorrect triage prediction in patients with high-priority codes (red/orange), suggesting overtriage in relation to seven-day mortality. This may be a protective measure for the patient. In contrast, the need for acute surgery within 72 h was affected by under-triage.
The triage nurse using Manchester Triage System can correctly prioritise the majority of patients with acute abdominal pain, especially in low acuity patients. The Manchester Triage System is safe and does not underestimate the severity of the patients.
大约有 5%至 10%的急诊科患者患有急性腹痛。分诊在患者分层中起着关键作用，确定需要立即治疗的患者和可以安全等待的患者。在这方面，本研究旨在估计曼彻斯特分诊系统在分类急性腹痛患者方面的性能。
回顾性纳入 2017 年 1 月 1 日至 2019 年 6 月 30 日期间在梅拉诺医院急诊科就诊的 9851 例急性腹痛患者。该研究根据 STROBE 声明进行和报告。通过验证患者接受的分诊分类及其在 7 天内的生存情况或在急诊科就诊后 72 小时内需要急症手术，估计曼彻斯特分诊系统的敏感性和特异性。
在患有急性腹痛的患者中（中位年龄 50 岁），0.4%在 7 天内死亡，8.9%在 72 小时内需要手术。与 7 天内死亡相关，其敏感性为 44.7%（29.9-61.5），特异性为 95.4%（94.9-95.8），阴性预测值为 99.7%（99.2-100）。
曼彻斯特分诊系统具有良好的特异性和阴性预测值。然而，由于高优先级代码（红色/橙色）患者的分诊预测错误较多，其敏感性较低，提示与 7 天死亡率相关的分诊过度。这可能是对患者的一种保护措施。相比之下，72 小时内需要急症手术的情况受到分诊不足的影响。
使用曼彻斯特分诊系统的分诊护士可以正确确定大多数急性腹痛患者的优先级，特别是低危患者。曼彻斯特分诊系统是安全的，不会低估患者的严重程度。
