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Validity of the Manchester Triage System in paediatric emergency care
  1. J Roukema1,
  2. E W Steyerberg2,
  3. A van Meurs3,
  4. M Ruige3,
  5. J van der Lei4,
  6. H A Moll5
  1. 1Sophia Children’s Hospital, Rotterdam, The Netherlands
  2. 2Department of Public Health, Center for Medical Decision Making, Rotterdam, The Netherlands
  3. 3Haga Hospital, Juliana Children’s Hospital Site, The Hague, The Netherlands
  4. 4Department of Medical Informatics, Rotterdam, The Netherlands
  5. 5Department of General Paediatrics, Sophia Children’s Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
  1. Correspondence to:
 H A Moll
 Department of General Paediatrics, Room SP 1540, Sophia Children’s Hospital, Erasmus Medical Centre, PO Box 2060, 3000 CB Rotterdam, The Netherlands;h.a.moll{at}


Objective: To assess the validity of the Manchester Triage System (MTS) in paediatric emergency care, using information on vital signs, resource utilisation and hospitalisation.

Methods: Patients were eligible if they had attended the emergency department of a large inner-city hospital in The Netherlands from August 2003 to November 2004 and were <16 years of age. A representative sample of 1065 patients was drawn from 18 469 eligible patients. The originally assigned MTS urgency levels were compared with resource utilisation, hospitalisation and a predefined reference classification for true urgency, based on vital signs, resource utilisation and follow-up. Sensitivity, specificity and percentage of overtriage and undertriage of the MTS were calculated.

Results: The number of patients who used more than two resources increased with a higher level of MTS urgency. The percentage of hospital admissions increased with the increase in level of urgency, from 1% in the non-urgent patients to 54% in emergent patients. According to the reference classification, the sensitivity of the MTS to detect emergent/very urgent cases was 63%, and the specificity was 78%. Undertriage occurred in 15% of patients, of which 96% were by one urgency category lower than the reference classification. Overtriage occurred in 40%, mostly in lower MTS categories. In 36% of these cases, the MTS classified two or more urgency categories higher than the reference classification.

Conclusions: The MTS has moderate sensitivity and specificity in paediatric emergency care. Specific modifications of the MTS should be considered in paediatric emergency care to reduce overtriage, while maintaining sensitivity in the highest urgency categories.

  • MTS, Manchester Triage System

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  • Competing interests: None.

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