The effectiveness of a modified Manchester Triage System for geriatric patients: A retrospective quantitative study

Abstract

Aim: Geriatric patients are increasingly dominating the daily routine in emergency department (ED). The atypical clinical presentation of disease, multimorbidity, frailty and cognitive impairment of geriatric patients pose particular challenges for triage in the ED. Efficient and accurate emergency triage plays a key role in differentiating between geriatric patients who need timely treatment and those who can wait safely. The purpose of this study was to evaluate the performance of the modified Manchester Triage System (mMTS) in classifying geriatric patients.

Design: An observational retrospective study.

Methods: A retrospective study of 18,796 geriatric patients (≥65 years) attending the ED of a tertiary care hospital in Zhejiang province between 1 June 2020 and 30 June 2022. Baseline information on patients was collected and divided into two different study groups according to triage level: high priority (red/orange) and low priority (yellow/green). The sensitivity and specificity of the mMTS were estimated by verifying the triage classification received by the emergency geriatric patients and their survival at 7 days or the need for acute surgery within 72 h.

Results: The study included a total of 17,764 geriatric patients with a median age of 72 years in ED. 10.7% (1896/17,764) of the geriatric patients were assigned to the high priority code group (red/orange) and 89.3% (15,868/17,764) were in the low priority code group (yellow/green). The sensitivity of the mMTS associated with death within 7 days was 85.7% (77.5-91.4), specificity was 89.8% (89.3-90.2), and accuracy was 89.8% (89.3-90.2). 1.8% of patients required surgery within 72 h. The sensitivity was 62.6% (57.0-67.9), specificity was 90.3% (89.8-90.7), and negative predictive value was 99.2% (99.0-99.4).

Conclusions: The mMTS has good specificity, accuracy and negative predictive value for geriatric patients. However, its incorrect prediction of triage in high-priority code patients results in lower sensitivity, which may serve as a protective strategy for these individuals. The current emergency triage system does not completely screen geriatric patients with severe acute illness who present to the ED, and it is necessary to add comprehensive assessment tools that match the characteristics of geriatric patients to improve triage outcomes.

Keywords: emergency department; geriatric patients; modified Manchester Triage System; nurse triage; triage.

FIGURE 1

Flowchart of patient enrolment. A total of 254,456 patients were treated in the emergency department during the study and 18,796 participants who met the criteria were enrolled in the study. 1032 patients were excluded due to untraceable outcomes, leaving 17,764 participants according to the classification level of the mMTS, 1896 patients were assigned to the high priority code group and 15,868 patients were assigned to the low priority code group. A final retrospective analysis of the 17,764 patients was performed.

FIGURE 2

ROC curves for mMTS priority codes that death within 7 days. The individual performance of each priority code is also highlighted. LR+, positive likelihood ratio; LR‐, negative likelihood ratio.