Zaboli Arian, Sibilio Serena, Brigiari Gloria, Massar Magdalena, Pfeifer Norbert, Brigo Francesco, Turcato Gianni
Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), 39100 Bolzano, Italy.
Department Public Health, Institute of Nursing Science, Universität Basel, 4051 Basel, Switzerland.
Diagnostics (Basel). 2025 Apr 22;15(9):1055. doi: 10.3390/diagnostics15091055.
Emergency department (ED) triage systems aim to prioritize patients based on clinical severity, ensuring timely intervention for high-risk cases. Recently, the National Early Warning Score (NEWS) has been proposed as an alternative to traditional triage systems, but its efficacy across multiple clinical outcomes remains unclear. This study aimed to compare the predictive performance of the NEWS and the Manchester Triage System (MTS) across multiple clinical outcomes. We conducted a retrospective, single-center study at Merano Hospital, Italy, from 1 June 2022 to 30 June 2023, comparing the performance of the NEWS and the Manchester Triage System (MTS). All adult ED patients (≥18 years) were included, while exclusions applied to those on fast-track pathways, non-residents, and pregnant patients. Primary outcomes included 30-day mortality, hospitalization, and ICU admission. A random 5% subgroup was analyzed for secondary outcomes, including the need for life-saving interventions (LSIs), physician-defined clinical priority, and severity. Predictive performance was assessed using Receiver Operating Characteristic (ROC) curves, area under the ROC curve (AUROC) comparisons, and Decision Curve Analysis (DCA). Among 27,238 patients, the NEWS predicted 30-day mortality more accurately than the MTS (AUROC 0.745 vs. 0.701, < 0.001). However, the MTS outperformed the NEWS for hospitalization (AUROC 0.733 vs. 0.609, < 0.001), ICU admission (AUROC 0.862 vs. 0.672, < 0.001), and all secondary outcomes. DCA further confirmed MTS's superiority across clinically relevant ED probability thresholds (20-40%). The NEWS, while effective for predicting mortality, it is inadequate in comprehensive triage decision-making. The MTS remains the superior system for prioritizing high-risk patients based on clinical severity. Rather than replacing triage with the NEWS, efforts should focus on refining existing systems to improve risk stratification. Future multi-center prospective studies are necessary to validate these findings.
急诊科（ED）分诊系统旨在根据临床严重程度对患者进行优先排序，确保对高危病例及时进行干预。最近，国家早期预警评分（NEWS）已被提议作为传统分诊系统的替代方案，但其在多种临床结局方面的有效性仍不明确。本研究旨在比较NEWS和曼彻斯特分诊系统（MTS）在多种临床结局方面的预测性能。我们于2022年6月1日至2023年6月30日在意大利梅拉诺医院进行了一项回顾性单中心研究，比较了NEWS和曼彻斯特分诊系统（MTS）的性能。纳入了所有成年急诊科患者（≥18岁），而快速通道患者、非本地居民和孕妇被排除在外。主要结局包括30天死亡率、住院治疗和重症监护病房（ICU）入院。对一个随机抽取的5%的亚组进行了次要结局分析，包括是否需要救生干预（LSIs）、医生定义的临床优先级和严重程度。使用受试者工作特征（ROC）曲线、ROC曲线下面积（AUROC）比较和决策曲线分析（DCA）评估预测性能。在27238例患者中，NEWS对30天死亡率的预测比MTS更准确（AUROC分别为0.745和0.701，<0.001）。然而，在住院治疗（AUROC分别为0.733和0.609，<0.001）、ICU入院（AUROC分别为0.862和0.672，<0.001）以及所有次要结局方面，MTS的表现优于NEWS。DCA进一步证实了MTS在临床相关的急诊科概率阈值（20%-40%）范围内的优越性。NEWS虽然在预测死亡率方面有效，但在综合分诊决策方面存在不足。MTS仍然是基于临床严重程度对高危患者进行优先排序的更优系统。不应以NEWS取代分诊，而应致力于完善现有系统以改善风险分层。未来需要进行多中心前瞻性研究来验证这些发现。
