ArticleBMJ (Clinical research ed.)2008
Manchester triage system in paediatric emergency care: prospective observational study.
Article in BMJ (Clinical research ed.), 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT02094404 (Triage of Children at the Emergency Department), which is not on this map. Cited by 56 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Triage of Children at the Emergency Department: Manchester Triage System or Pediatric Early Warning Score?
Who cites it
56 citing papers in PubMed, 1 synthesis or guideline pooled it, 158 citations in OpenAlex.
- Reporting and methods in clinical prediction research: a systematic review.PLoS medicine · 2012Pooled it
- Implementation of a checklist to improve pediatric trauma assessment quality in a Brazilian hospital.Pediatric surgery international · 2021Trial
- Trial
- Manchester Triage System: Effectiveness, Limitations, and Global Implementation-A Structured Narrative Review.Healthcare (Basel, Switzerland) · 2026Review
- Observational
- Relieving the pediatric emergency department by referring low triaged patients using the Manchester Triage System.European journal of pediatrics · 2025Article
- Aspects of triage for infants: a narrative review.European journal of pediatrics · 2025Review
- Article
- Clinical support system for triage based on federated learning for the Korea triage and acuity scale.Heliyon · 2023Article
- Whole-Body Magnetic Resonance Tomography and Whole-Body Computed Tomography in Pediatric Polytrauma Diagnostics-A Retrospective Long-Term Two-Center Study.Diagnostics (Basel, Switzerland) · 2023Article
- Development of outcomes for evaluating emergency care triage: a Delphi approach.Scandinavian journal of trauma, resuscitation and emergency medicine · 2023Article
- Validity of the Paediatric Canadian Triage Acuity Scale in a Tertiary Hospital: An Analysis of Severity Markers' Variability.Journal of medical systems · 2023Article
- Improving the safety of the Manchester triage system for children with congenital heart disease.European journal of pediatrics · 2022Article
- Effect of In-Situation Versus Manchester Triage System-Based Initial Case Management on Hospital-Based Mortality: A Before and After Study.Indian journal of pediatrics · 2022Article
- Validation of a five-level triage system in pediatric trauma and the effectiveness of triage nurse modification: A multi-center cohort analysis.Frontiers in medicine · 2022Article
- Validation of the Computerized Pediatric Triage Tool,Frontiers in pediatrics · 2022Article
- Pediatric emergency triage systems.Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo · 2022Review
- Analysis of Plastic Surgery Consultations in a High-Volume Paediatric Emergency Department: A Quality Improvement Initiative.Plastic surgery (Oakville, Ont.) · 2021Article
- Validation of Dutch Obstetric Telephone Triage System: A Prospective Validation Study.Risk management and healthcare policy · 2021Article
- Observational
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
7 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo validate use of the Manchester triage system in paediatric emergency care.
designProspective observational study.
settingEmergency departments of a university hospital and a teaching hospital in the Netherlands, 2006-7.
participants17,600 children (aged <16) visiting an emergency department over 13 months (university hospital) and seven months (teaching hospital).
interventionNurses triaged 16,735/17,600 patients (95%) using a computerised Manchester triage system, which calculated urgency levels from the selection of discriminators embedded in flowcharts for presenting problems. Nurses over-ruled the urgency level in 1714 (10%) children, who were excluded from analysis. Complete data for the reference standard were unavailable in 1467 (9%) children leaving 13,554 patients for analysis.
main outcome measuresUrgency according to the Manchester triage system compared with a predefined and independently assessed reference standard for five urgency levels. This reference standard was based on a combination of vital signs at presentation, potentially life threatening conditions, diagnostic resources, therapeutic interventions, and follow-up. Sensitivity, specificity, and likelihood ratios for high urgency (immediate and very urgent) and 95% confidence intervals for subgroups based on age, use of flowcharts, and discriminators.
resultsThe Manchester urgency level agreed with the reference standard in 4582 of 13,554 (34%) children; 7311 (54%) were over-triaged and 1661 (12%) under-triaged. The likelihood ratio was 3.0 (95% confidence interval 2.8 to 3.2) for high urgency and 0.5 (0.4 to 0.5) for low urgency; though the likelihood ratios were lower for those presenting with a medical problem (2.3 (2.2 to 2.5) v 12.0 (7.8 to 18.0) for trauma) and in younger children (2.4 (1.9 to 2.9) at 0-2 months [corrected] v 5.4 (4.5 to 6.5) at 8-16 years).
conclusionsThe Manchester triage system has moderate validity in paediatric emergency care. It errs on the safe side, with much more over-triage than under-triage compared with an independent reference standard for urgency. Triage of patients with a medical problem or in younger children is particularly difficult.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.