Predictive value of the Manchester Triage System: evaluation of patients’
               clinical outcomes

Guedes, Helisamara Mota; Martins, José Carlos Amado; Chianca, Tânia Couto Machado

doi:10.1590/0034-7167.2015680107p

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• Rev Bras Enferm 68 (1) • Jan-Feb 2015 • https://doi.org/10.1590/0034-7167.2015680107i copy

Predictive value of the Manchester Triage System: evaluation of patients’ clinical outcomes

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to analyze the predictive value of the Manchester Triage System in relation to clinical outcome of patients.

Methods:

prospective observational study of 577 patients admitted to the ER and subjected to risk classification. The Therapeutic Intervention Scoring System-28 (TISS-28) was used to measure the severity of patients (primary outcome) and secondary outcomes: high / transfer, death, and length of hospital stay. Descriptive and univariate analyzes were conducted.

Results:

patients classified as red are 10.7 times more likely to have scores above 14 in TISS-28 in relation to others. Patients classified as red have 5.9 times more chance of progression to death compared to others. Patients of high priority service are 1.5 times more likely to be hospitalized over five days than low priority.

Conclusions:

STM proved a good predictor of clinical outcomes.

Nursing; Emergency Medical Services; Triage; Clinical Evolution

Coding Groups	TISS-28			Comparison group	*p value^ Note: P calculated by Mann Whitney test adjusted by Bonferroni for p<0,01. Kuskal Wallis test, p<0,001.*
Coding Groups	Median	95% IC	Min-Max	Comparison group
Red	31.00	[23.53-32.28]	9-45	Orange	<0.001
				Yellow	<0.001
				Green	<0.001
				White	<0.001
Orange	15.50	[16.11-18.20]	8-47	Yellow	<0.001
				Green	<0.001
				White	<0.001
Yellow	14.00	[14.06-15.53]	7-50	Green	0.153
				White	<0.001
Green/Blue	13.00	[12.35-14.78]	7-34	White	0.037

Coding groups	Length of hospital stay				Comparison Group	p value*
Coding groups	Mean	Median	95% CI	Min-Max	Comparison Group	p value*
Red	10.6	8.00	[5.9 - 15.2]	2-41	Orange	0.560
					Yellow	0.195
					Green	0.190
					White	0.006
Orange	8.59	5.00	[7.1 - 10.0]	1-64	Yellow	0.044
					Green	0.102
					White	<0.001
Yellow	6.95	5.00	[6.13 -7.76]	1 - 60	Green	0.726
					White	0.001
Green/Blue	6.97	5.00	[5.0-8.8]	1 - 43	White	0.011
White	4.93	3.00	[3.8-6.0]	1 - 23	-	-

Risk Classification	Outcome						Total		p value*
	Discharge		Death		Referral		Total
	n	%	n	%	n	%	n	%
Red	12	2.1	9	1.5	-	-	21	3.6
Orange	122	21.1	27	4.8	9	1.5	158	27.4
Yellow	233	40.3	24	4.2	10	1.8	267	46.3	<0.001
Green/Blue	55	9.5	6	1.0	2	0.4	63	10.9	<0.001
White	60	10.5	5	0.8	3	0.5	68	11.8
All patients	482	83.5	71	12.3	24	4.2	577	100

Outcome	High Priority	Low Priority	Red	Orange	Yellow	Green/Blue	White
TISS-28 >14
OR	3.160	0.316	10.779	2.778	0.708	0.469	0.341
95% CI	2.148-4.647	0.215-0.466	2.487-46.717	1.894-4.076	0.509-0.984	0.268-0.821	0.193-0.600
P	<0.001	<0.001	0.001	<0.001	0.040	0.008	<0.001
Length of hospital stay >5 days
OR	1.504	0.665	1.985	1.457	0.842	0.907	0.614
95% CI	1.041-2.172	0.460-0.960	0.823-4.789	1.007-2.108	0.603-1.176	0.528-1.557	0.356-1.057
P	0.030	0.030	0.127	0.046	0.313	0.723	0.079
Death
OR	2.509	0.399	5.964	1.752	0.551	0.740	0.532
95% CI	1.486-4.237	0.236-0.673	2.416-14.723	1.043-2.943	0.327-0.928	0.307-1.786	0.206-1.370
P	0.001	0.001	<0.001	0.034	0.025	0.503	0.191

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[1] CORRESPONDING AUTHOR: Helisamara Mota Guedes. E-mail: helisamaraguedes@gmail.com