Article Text

Download PDFPDF
The Manchester triage system: improvements for paediatric emergency care
  1. Mirjam van Veen1,
  2. Ewout W Steyerberg2,
  3. Mariët van't Klooster1,
  4. Madelon Ruige3,
  5. Alfred H J van Meurs3,
  6. Johan van der Lei4,
  7. Henriëtte A Moll1
  1. 1Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
  2. 2Center for Medical Decision Making, Public Health, Erasmus MC, Rotterdam, The Netherlands
  3. 3Department of Paediatrics, Haga Hospital, Juliana Children's Hospital, The Hague, The Netherlands
  4. 4Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Professor Henriëtte Moll, Department of Paediatrics, Room Sp 1540, Erasmus MC-Sophia Children's Hospital, PO Box 2060, Rotterdam 3000 CB, The Netherlands; h.a.moll{at}


Objective To improve the Manchester Triage System (MTS) in paediatric emergency care.

Methods The authors performed a prospective observational study at the emergency departments of a university and teaching hospital in The Netherlands and included children attending in 2007 and 2008. The authors developed and implemented specific age-dependent modifications for the MTS, based on patient groups where the system's performance was low. Nurses applied the modified system in 11 481 (84%) patients. The reference standard for urgency defined five levels based on a combination of vital signs at presentation, potentially life-threatening conditions, diagnostic resources, therapeutic interventions and follow-up. The reference standard for urgency was previously defined and available in 11 260/11 481 (96%) patients.

Results Compared with the original MTS specificity improved from 79% (95% CI 79% to 80%) to 87% (95% CI 86% to 87%) while sensitivity remained similar ((63%, 95% CI 59% to 66%) vs (64%, 95% CI 60% to 68%)). The diagnostic OR increased (4.1 vs 11).

Conclusions Modifications of the MTS for paediatric emergency care resulted in an improved specificity while sensitivity remained unchanged. Further research should focus on the improvement of sensitivity.

  • Triage
  • epidemiology
  • emergency medical services
  • child
  • emergency department
  • paediatrics
  • paediatric emergency medicine

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Study design Prospective observational study.

  • Online appendix Reference classification parameters, matrix and definitions of reference urgency categories.

  • Funding Netherlands Organisation for Health Research and Development (ZonMw) and Erasmus University Medical Centre, Rotterdam, Netherlands. None of the granting agencies listed had any role in the design and conduct of the interpretation of the data or preparation, review or approval of the manuscript.

  • Competing interests None.

  • Ethics approval The ethics approval was provided by the Institutional medical ethics committee; the requirement for informed consent was waived.

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