Zaboli Arian, Brigo Francesco, Sibilio Serena, Brigiari Gloria, Massar Magdalena, Parodi Marta, Mian Michael, Pfeifer Norbert, Turcato Gianni
Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy.
Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy.
Int Emerg Nurs. 2025 Feb;78:101540. doi: 10.1016/j.ienj.2024.101540. Epub 2024 Nov 19.
Currently, there is no universally accepted gold standard outcome for assessing the effectiveness of the Triage Systems. This study aimed to comprehensively evaluate and compare various outcomes utilized in triage studies.
A prospective observational study was conducted at the Emergency Department (ED) of Merano Hospital from June 1 to December 31, 2023. We assessed the predictive capability of the Manchester Triage System (MTS) across multiple outcomes using areas under the receiver operating characteristic curve (AUROC), along with their corresponding 95% confidence intervals (95% CI), and frequency distributions.
The MTS demonstrated strong performance concerning the most objective outcomes, such as mortality (at 72 h: AUROC 0.914; 95 %CI: 0.815-1; at 7 days: 0.845; 95 %CI: 0.729-0.965; at 30 days: 0.794; 95 %CI: 0.706-0.881), admission to the intensive care unit (0.831; 95 %CI: 0.763-0.899), and need for life-saving interventions (0.870; 95 %CI: 0.806-0.934). Additionally, outcomes such as urgency status and clinical priority, as judged by physicians, exhibited excellent performance and optimal frequency distribution.
The performance of the MTS varied significantly depending on the specific outcome under evaluation. Currently, no single outcome appears superior to others, nor does any seem poised to serve as a potential gold standard for the assessment of triage systems. It is advisable for dedicated working groups to convene and reach a consensus on the most effective outcomes for evaluating the performance of MTS and other triage systems. This should be accomplished through a systematic, standardized, and transparent approach, grounded in the best available evidence.
目前，在评估分诊系统的有效性方面，尚无普遍接受的金标准结局。本研究旨在全面评估和比较分诊研究中使用的各种结局。
于2023年6月1日至12月31日在梅拉诺医院急诊科进行了一项前瞻性观察性研究。我们使用受试者工作特征曲线下面积（AUROC）及其相应的95%置信区间（95%CI）以及频率分布，评估了曼彻斯特分诊系统（MTS）在多种结局方面的预测能力。
MTS在最客观的结局方面表现出色，如死亡率（72小时：AUROC 0.914；95%CI：0.815 - 1；7天：0.845；95%CI：0.729 - 0.965；30天：0.794；95%CI：0.706 - 0.881）、入住重症监护病房（0.831；95%CI：0.763 - 0.899）以及需要进行挽救生命的干预措施（0.870；95%CI：0.806 - 0.934）。此外，由医生判断的紧急程度状态和临床优先级等结局表现优异且频率分布最佳。
MTS的表现因所评估的具体结局而异。目前，没有单一结局明显优于其他结局，也没有任何一个结局似乎有望成为评估分诊系统的潜在金标准。建议专门的工作组召开会议，就评估MTS和其他分诊系统性能的最有效结局达成共识。这应该通过基于现有最佳证据的系统、标准化和透明的方法来实现。
