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Pain assessments at triage with the Manchester triage system: a prospective observational study
  1. Ineke van der Wulp1,
  2. Leontien M Sturms1,
  3. Annemarie de Jong2,
  4. Marian Schot-Balfoort2,
  5. Augustinus J P Schrijvers1,
  6. Henk F van Stel1
  1. 1Public Health, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
  2. 2Sint Antonius Hospital Nieuwegein/Utrecht Oudenrijn, Nieuwegein and Utrecht, The Netherlands
  1. Correspondence to Dr I van der Wulp, Julius Center for Health Sciences and Primary Care, UMC Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands; i.vanderwulp{at}


Objective Pain is one of the six general discriminators of the Manchester triage system (MTS). The frequency of pain assessments conducted at triage with the MTS, and patient, nurse and triage characteristics associated with pain assessments were studied. Also, nurses' reasons for not assessing pain at triage were studied.

Methods The study consisted of two parts. In part 1, nurses from two emergency departments (ED) registered patient characteristics and the process of triage for every presenting patient during 1 week in May 2009. The characteristics of triage nurses were registered on a second form. In part 2 of the study, 13 nurses were interviewed about reasons for not assessing pain at triage.

Results According to the MTS guidelines, pain assessments should have been conducted in 86.1% of the patient presentations. It was only assessed in 32.2% of these patients. Characteristics associated with conducting pain assessments were children under 12 years of age, patients referred by others than a general practitioner or ambulance service, intake of medication before an ED visit, experience of the nurse with the MTS and the duration of triage. Reasons for not assessing pain according to the guidelines included the thought of triage nurses that pain assessments result in overtriage.

Conclusions Pain assessments at triage are conducted infrequently because of insufficient education, conducting activities at triage that are not necessary for estimating urgency and a lack of clarity in the MTS guidelines. Changes in these areas are necessary to improve the reliability and validity of pain assessments and the MTS.

  • Emergency care systems
  • emergency departments
  • management

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  • Competing interests None declared.

  • Ethics approval This study was conducted with the approval of the Medical Ethical Committee of the Sint Antonius Hospitals Nieuwegein/Utrecht Oudenrijn.

  • Provenance and peer review Not commissioned; externally peer reviewed.