Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias · 2026
Exploring the triage accuracy of the Manchester Triage System and the Emergency Severity Index in emergency department patients with sepsis: A secondary retrospective analysis.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Schondelmaier Philipp, Slagman Anna, Möckel Martin, Fischer-Rosinský Antje, Reinhart Konrad, De La Cruz Macias Catalina, Stacke Angelika, Winning Johannes, Bauer Michael, Bolanaki Myrto
Аннотация
OBJECTIVE: To meet the requirement of the Sepsis-3 guidelines for rapid initiation of treatment, emergency department (ED) triage systems must assign patients with suspected sepsis to the highest-priority triage categories. Our aim was to explore how effectively the Manchester Triage System (MTS) and the Emergency Severity Index (ESI) assign these patients to appropriate urgency categories and avoid undertriage.
METHODS: A secondary analysis was conducted from a prospective, multicenter observational study (LIFE-POC), which included patients presenting with suspected organ dysfunction in 1 of 3 participant EDs (2 using MTS and 1 using ESI). The primary endpoint was a diagnosis of sepsis within 24 hours of ED presentation. Patients diagnosed with sepsis who were assigned to urgent triage categories 1, 2, or 3 were classified as accurately triaged. Ethical approval was granted by the committees of the participating centers.
RESULTS: A total of 388 out of 1,424 patients were diagnosed with sepsis within 24 hours of ED presentation. MTS showed a sensitivity rate of 88.2% (undertriage, 11.8%), while ESI reached 99.0% (undertriage, 1.0%). Both triage tools demonstrated low specificity: 17.5% (MTS) and 2.7% (ESI). Binary logistic regression analysis indicated that the probability of sepsis increased with higher urgency triage categories and decreased in lower urgency categories.
CONCLUSIONS: Both ESI and MTS demonstrated high sensitivity in assigning septic patients to higher urgency categories, with better performance by ESI. However, MTS showed superior discrimination between urgency levels and may therefore be more compatible with the resource limitations typically encountered in EDs.
METHODS: A secondary analysis was conducted from a prospective, multicenter observational study (LIFE-POC), which included patients presenting with suspected organ dysfunction in 1 of 3 participant EDs (2 using MTS and 1 using ESI). The primary endpoint was a diagnosis of sepsis within 24 hours of ED presentation. Patients diagnosed with sepsis who were assigned to urgent triage categories 1, 2, or 3 were classified as accurately triaged. Ethical approval was granted by the committees of the participating centers.
RESULTS: A total of 388 out of 1,424 patients were diagnosed with sepsis within 24 hours of ED presentation. MTS showed a sensitivity rate of 88.2% (undertriage, 11.8%), while ESI reached 99.0% (undertriage, 1.0%). Both triage tools demonstrated low specificity: 17.5% (MTS) and 2.7% (ESI). Binary logistic regression analysis indicated that the probability of sepsis increased with higher urgency triage categories and decreased in lower urgency categories.
CONCLUSIONS: Both ESI and MTS demonstrated high sensitivity in assigning septic patients to higher urgency categories, with better performance by ESI. However, MTS showed superior discrimination between urgency levels and may therefore be more compatible with the resource limitations typically encountered in EDs.