Observational studyScandinavian journal of trauma, resuscitation and emergency medicine2025
The association between urgency level and hospital admission, mortality and resource utilization in three emergency department triage systems: an observational multicenter study.
Observational study in Scandinavian journal of trauma, resuscitation and emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Reducing Mis-triage in Emergency Departments (RemEDy): Protocol for Improving Triage Accuracy Through Real-time Evaluation and Artificial Intelligence.JMIR research protocols · 2026Article
- Predictive triage for testing may improve control of a COVID-19 epidemic while reducing testing requirements.Archives of public health = Archives belges de sante publique · 2026Article
- Positive predictive value of Dutch Elder Abuse Scale (ERASE): an early warning tool for elder abuse in the emergency department and geriatric outpatient setting.BMC geriatrics · 2025Article
- Comparative Evaluation of Machine Learning and Specialist Physicians in Breast Care Triaging: A Real-World Observational Study.European journal of breast health · 2025Article
- Comment on van wegen et al.: the association between urgency level and hospital admission, mortality and resource utilization in three emergency department triage systems.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- Application of key link nursing based on feedforward control theory in the emergency rescue of multiple trauma patients.Frontiers in public health · 2025Article
- Gender perception of pareidolia faces in emergency department patients: the influence of physician gender.Frontiers in human neuroscience · 2025Article
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5 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundEffective triage systems are crucial for prioritizing patients based on urgency and optimizing resource utilization. An ideal triage system is expected to have low resource utilization, hospitalization and mortality among patients classified at low urgency levels. Furthermore, it should exhibit an increase in the risk of hospitalization and mortality as urgency levels increase, ensuring the most critically ill patients receive priority care first. However, it is unclear which triage system performs best.
objectiveTo compare the performance of the Manchester Triage System (MTS), the Emergency Severity Index (ESI), and the Netherlands Triage Standard (NTS) by investigating the association between urgency levels and resource utilization, hospitalization and in-hospital mortality in Emergency Department (ED) patients.
methodsObservational multicenter cohort study using data from the Netherlands Emergency department Evaluation Database, comprising seven representative EDs in six Dutch hospitals. All consecutive ED patients with a registered urgency level were included. Resource utilization, hospitalization and mortality were measured across all urgency levels. In each triage system, multivariable logistic regression was used to assess the association between urgency level and in-hospital mortality and hospitalization, adjusting for age, sex, presenting complaints and hospital type.
resultsA total of 696,518 ED visits (MTS 320,406 (46.1%), ESI 214,267 (30.8%), NTS 161,845 (23.3%) patients) were included. Resource utilization was substantially lower in the lowest urgency level of the ESI compared to the MTS and NTS. Hospitalization to a regular ward, cardiac, medium or intensive care unit in the least urgent level was 3.9% in the ESI, considerably lower than in the MTS (23.1%) and NTS (34.3%) (P < 0.05). Mortality in the lowest urgency level of the ESI was 0.8%, while in the MTS and NTS this was 6.3% and 12.4%, respectively (P < 0.05). In the ESI, the risk (Adjusted Odds Ratios) for hospitalization and mortality increased much more with increasing urgency levels compared to the MTS and NTS.
conclusionThis study suggests that the ESI may be more effective in distinguishing between patients with low and high urgency, with a reduced risk of undertriage when compared to the MTS and NTS.
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