The Manchester Triage System (MTS): a score for emergency management of patients with acute gastrointestinal bleeding

Abstract Background Suspected gastrointestinal (GI) bleeding is a common initial diagnosis in emergency departments. Despite existing endoscopic scores to estimate the risk of GI bleeding, the primary clinical assessment of urgency can remain challenging. The 5-step Manchester Triage System (MTS) is a validated score that is often applied for the initial assessment of patients presenting in emergency departments. Methods All computer-based records of patients who were admitted between January 2014 and December 2014 to our emergency department in a tertiary referral hospital were analyzed retrospectively. The aim of our retrospective analysis was to determine if patient triage using the MTS is associated with rates of endoscopy and with presence of active GI bleeding. Results In summary, 5689 patients with a GI condition were treated at our emergency department. Two hundred eighty-four patients (4.9 %) presented with suspected GI bleeding, and 165 patients (58 %) received endoscopic diagnostic. Endoscopic intervention for hemostasis was needed in 34 patients (21 %). In patients who underwent emergency endoscopy, triage into MTS categories with higher urgency was associated with higher rates of endoscopic confirmation of suspected GI bleeding (79 % of patients with MTS priority levels 1 or 2, 53 % in level 3 patients, and 40 % in levels 4 or 5 patients; p = 0.024). Conclusions The MTS is an established tool for triage in emergency departments and could have a potential to guide early clinical decision-making with regards to urgency of endoscopic evaluation in patients with suspected GI bleeding.

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The presentational flow chart “unwell adult” of the Manchester Triage System—Curse or blessing?

PLoS ONE ◽

10.1371/journal.pone.0252730 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252730

Author(s):

Vanessa Brutschin ◽

Monika Kogej ◽

Sylvia Schacher ◽

Moritz Berger ◽

Ingo Gräff

Keyword(s):

Emergency Department ◽

Older Patients ◽

Emergency Department Visits ◽

Flow Chart ◽

Initial Assessment ◽

Considerable Proportion ◽

Triage System ◽

Manchester Triage System ◽

Flow Charts ◽

Observation Period

Background The presentational flow chart “unwell adult” of the Manchester Triage System (MTS) occupies a special role in this triage system, defined as the nonspecific presentation of an emergency patient. Current scientific studies show that a considerable proportion of emergency room patients present with so-called "nonspecific complaints". The aim of the present study is to investigate in detail the initial assessment of emergency patients triaged according to the presentational flow chart "unwell adult". Methods Monocentric, retrospective observational study. Results Data on 14,636 emergency department visits between March 12th and August 12th, 2019 were included. During the observation period, the presentational flow chart "unwell adult" was used 1,143 times and it was the third most frequently used presentational flow chart. Patients triaged with this flow chart often had unspecific complaints upon admission to the emergency department. Patients triaged with the “unwell adult” chart were often classified with a lower triage level. Notably, patients who died in hospital during the observation period frequently received low triage levels. The AUC for the MTS flow chart “unwell adult” and hospitalization in general for older patients (age ≥ 65 years) was 0.639 (95% CI 0.578–0.701), and 0.730 (95% CI 0.714–0.746) in patients triaged with more specific charts. The AUC for the MTS flow chart “unwell adult” and admission to ICU for older patients (age ≥65 years) was 0.631 (95% CI 0.547–0.715) and 0.807 (95% CI 0.790–0.824) for patients triaged with more specific flow charts. Comparison of the predictive ability of the MTS for in-hospital mortality in the group triaged with the presentational flow chart “unwell adult” revealed an AUC of 0.682 (95% CI 0.595–0.769) vs. 0.834 (95% CI 0.799–0.869) in the other presentational flow charts. Conclusion The presentational flow chart "unwell adult" is frequently used by triage nurses for initial assessment of patients. Patient characteristics assessed with the presentational flow chart "unwell adult" differ significantly from those assessed with MTS presentational flow charts for more specific symptoms. The quality of the initial assessment in terms of a well-functioning triage priority assessment tool is less accurate than the performance of the MTS described in the literature.

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Features of glomerular filtration rate evaluation for kidney function assessment in patients with rheumatoid arthritis

Medical alphabet ◽

10.33667/2078-5631-2020-15-44-48 ◽

2020 ◽

pp. 44-48

Author(s):

V. A. Aleksandrov ◽

L. N. Shilova ◽

A. V. Aleksandrov

Keyword(s):

Rheumatoid Arthritis ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Cystatin C ◽

Filtration Rate ◽

Clinical Decision Making ◽

Clinical Decision ◽

Initial Assessment ◽

Serum Cystatin C ◽

Creatinine Concentration

The development of renal dysfunction in patients with rheumatoid arthritis (RA) is due to the presence and severity of autoimmune disorders, chronic systemic inflammation, a multiplicity of comorbid conditions, and pharmacotherapy features. The most important parameter that describes the general condition of the kidneys is glomerular filtration rate (GFR). This review presents the data on the possibilities of modern methods for determining estimated GFR (e-GFR) and the specificity of their use in various clinical situations that accompany the course of RA. For the initial assessment of GFR in patients with RA it is advisable to use the measurement of e-GFR based on serum creatinine concentration using the CKD-EPI equation (2009) (with or without indexing by body surface area). In cases where the e-GFR equations are not reliable enough or the results of this test are insufficient for clinical decision making, the serum cystatin C level should be measured and the combined GFR calculation based on creatinine and cystatin C should be used.

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Performance of the Manchester triage system in older emergency department patients: a retrospective cohort study

BMC Emergency Medicine ◽

10.1186/s12873-018-0217-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 7

Author(s):

Steffie H. A. Brouns ◽

Lisette Mignot-Evers ◽

Floor Derkx ◽

Suze L. Lambooij ◽

Jeanne P. Dieleman ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Triage System ◽

Manchester Triage System ◽

Emergency Department Patients

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LUNG ULTRASOUND DURING COVID-19 PANDEMICS: WHY, HOW AND WHEN?

Wiadomości Lekarskie ◽

10.36740/wlek202108101 ◽

2021 ◽

Vol 74 (8) ◽

pp. 1783-1788

Author(s):

Khrystyna O. Pronyuk ◽

Liudmyla O. Kondratiuk ◽

Andrii D. Vysotskyi ◽

Olga A. Golubovska ◽

Iryna M. Nikitina

Keyword(s):

Hospital Stay ◽

Clinical Decision Making ◽

Lung Ultrasound ◽

Limited Resource ◽

Clinical Decision ◽

Lung Damage ◽

Dynamic Monitoring ◽

Initial Assessment ◽

X Ray ◽

Chest X Ray

The aim: To optimize diagnostic of pathological processes in lungs affected by COVID-19, dynamic monitoring and clinical decision making using lung ultrasound in limited resources settings. Materials and methods: Between the onset of pandemics and January 2021, approximately 9000 patients have been treated for confirmed COVID-19 in the Olexandrivska Clinical Hospital. Assessment of all hospitalized patients included hematology, chemistries and proinflammatory cytokines – IL-6, CRP, procalcitonin, ferritin. Diagnosis was confirmed by PCR for SARS-CoV-2 RNA. Chest X-ray was performed in all hospitalized cases, while CT was available approximately in 30% of cases during hospital stay. Lung ultrasound was proactively utilized to assess the type and extent of lung damage and to monitor the progress of disease in patients hospitalized into the ICU and Infection Unit (n=135). Ultrasound findings were recorded numerically based on scales. Results: In the setting of СOVID-19, bedside lung ultrasound has been promptly recognized as a tool to diagnose and monitor the nature and extent of lung injury. Lung ultrasound is a real time assessment, which helps determine the nature of a pathologic process affecting lungs. In this paper the accuracy of bedside LUS, chest X-ray and computer tomography are compared based on clinical cases, typical for COVID-19 lung ultrasound appearance is evaluated. Described in article data is collected in one of the biggest facility that deals with COVID-19. Chest X-ray was performed in all hospitalized cases, while CT was available approximately in 30% of cases during hospital stay. The cases presented in the paper indicate potential advantages to the use of ultrasound in limited resource healthcare settings, especially when the risk of transportation to CT outweighs the value of information obtained. Conclusions: Grading of ultrasonographic findings in the lungs was sufficient for both initial assessment with identification of high risk patients, and routine daily monitoring. Hence, lung ultrsound may be used to predict deterioration, stratify risks and make clinical decisions.

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SIKAP DAN PENGETAHUAN PERAWAT BERHUBUNGAN DENGAN PELAKSANAAN TRIAGE

Jurnal Kebidanan ◽

10.35872/jurkeb.v9i02.317 ◽

2018 ◽

Vol 9 (02) ◽

pp. 154

Author(s):

Dewi Ratna Sari ◽

Sutanta .

Keyword(s):

Emergency Department ◽

Clinical Decision Making ◽

Initial Assessment ◽

Rank Test ◽

P Value ◽

Hospital Emergency Department ◽

Hospital Emergency ◽

Cross Sectional ◽

Spearman Rank ◽

Emergency Units

ABSTRAKPerawat yang bekerja di unit gawat darurat (UGD) harus memiliki sikap, ketrampilan dan kemampuan untuk mengatur kemampuan fungsional dalam berbagai kondisi. Perawat harus mampu memprioritaskan perawatan pasien atas dasar pengambilan keputusan klinis dimana keterampilan penting bagi perawat dalam penilaian awal. Untuk mendukung hal tersebut diperlukan pengetahuan, sikap dan ketrampilan dalam hal pemisahan jenis dan kegawatan pasien dalam triage, sehingga dalam penanganan pasien bisa lebih optimal dan terarah. Tujuan penelitian untuk mengetahui hubungan sikap dan pengetahuan perawat dalam pelaksanaan triage di UGD RSUD Wonosari. Penelitian ini menggunakan survei analitik korelasi dengan pendekatan cross sectional. Populasi penelitian berjumlah 15 perawat yang bekerja di ruang gawat darurat, dengan metode pengambilan sampel secara total sampling. Instrumen penelitian berupa kuisioner, metode analisa data menggunakan uji spearman rank dan regresi linier berganda. Hasil penelitian tidak terdapat hubungan antara sikap dengan pelaksanaan triage di UGD RSUD Wonosari, hal ini ditunjukkan dari hasil uji Spearman rank dengan nilai sig 0,354>p-value 0,05. Terdapat hubungan antara pengetahuan dengan pelaksanaan triage di UGD RSUD Wonosari. Hal ini ditunjukkan dari nilai rank spearman 0,004 < p-value 0,05. Sehingga pelaksanaan triage dipengaruhi faktor lain yang tidak terangkum dalam analisis ini. Kesimpulan tidak ada hubungan antara sikap dengan pelaksanaan triage di UGD RSUD Wonosari. Ada hubungan antara pengetahuan dengan pelaksanaan triage di UGD RSUD Wonosari.Kata Kunci: sikap, pengetahuan, pelaksanaan triageNURSE’S ATTITUDE AND KNOWLEDGE RELATED WITH IMPLEMENTATION OF TRIAGEABSTRACTNurses working in emergency units must have the attitude, skills and ability to organize functional abilities under various conditions. Nurses should be able to prioritize patient care on the basis of clinical decision-making where skills are important to nurses in the initial assessment. To support it requires knowledge, attitude and skills in terms of separation of types and gravity of patients in triage, so that in the handling of patients can be more optimal and directed. The purpose of this research is to know the relationship of attitude and knowledge of nurses in the implementation of triage in emergency units Wonosari Hospital. This research uses analytic correlation survey with cross sectional approach. The study population was 15 nurses working in the emergency room, with sampling method in total sampling. The research instrument is questionnaire, data analysis method using spearman rank test and multiple linear regression. The result of this research shows that there is no correlation between attitude with triage implementation in emergency units Wonosari Hospital, it is shown from Spearman rank test with sig value 0,354> p-value 0,05. There is a relationship between knowledge with triage implementation at Wonosari Hospital emergency department. It is shown from spearman rank value 0,004 <p-value 0,05. So the implementation of triage is influenced by other factors not summarized in this analysis. Conclusion there is no relation between attitude with triage implementation in Wonosari Hospital emergency department. There is a relationship between knowledge with triage implementation in emergency units Wonosari Hospital.Keywords: attitude, knowledge, implementation of triage

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Clinical decision making in the emergency department setting using rapid PCR: Results of the CLADE study group

Journal of Clinical Virology ◽

10.1016/j.jcv.2018.02.013 ◽

2018 ◽

Vol 102 ◽

pp. 42-49 ◽

Cited By ~ 17

Author(s):

Glen T. Hansen ◽

Johanna Moore ◽

Emily Herding ◽

Tami Gooch ◽

Diane Hirigoyen ◽

...

Keyword(s):

Decision Making ◽

Emergency Department ◽

Clinical Decision Making ◽

Clinical Decision ◽

Study Group ◽

Rapid Pcr ◽

Emergency Department Setting

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Current triage practice and influences affecting clinical decision-making in emergency departments in NSW, Australia

Accident and Emergency Nursing ◽

10.1054/aaen.2001.0268 ◽

2001 ◽

Vol 9 (4) ◽

pp. 227-234 ◽

Cited By ~ 25

Author(s):

M. Fry ◽

G. Burr

Keyword(s):

Decision Making ◽

Emergency Departments ◽

Clinical Decision Making ◽

Clinical Decision

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Type of facility influences lengths of stay of children presenting to high volume emergency departments

BMC Pediatrics ◽

10.1186/s12887-020-02400-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Rhonda J. Rosychuk ◽

Brian H. Rowe

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Emergency Departments ◽

High Volume ◽

Population Based ◽

Initial Assessment ◽

Teaching Hospitals ◽

Emergency Department Crowding ◽

Academic Teaching ◽

The Impact

Abstract Background Emergency department crowding may impact patient and provider outcomes. We describe emergency department crowding metrics based on presentations by children to different categories of high volume emergency departments in Alberta, Canada. Methods This population-based retrospective study extracted all presentations made by children (age < 18 years) during April 2010 to March 2015 to 15 high volume emergency departments: five regional, eight urban, and two academic/teaching. Time to physician initial assessment, and length of stay for discharges and admissions were calculated based on the start of presentation and emergency department facility. Multiple metrics, including the medians for hourly, facility-specific time to physician initial assessment and length of stay were obtained. Results About half (51.2%) of the 1,124,119 presentations were made to the two academic/teaching emergency departments. Males presented more than females (53.6% vs 46.4%) and the median age was 5 years. Pediatric presentations to the three categories of emergency departments had mostly similar characteristics; however, urban and academic/teaching emergency departments had more severe triage scores and academic/teaching emergency departments had higher admissions. Across all emergency departments, the medians of the metrics for time to physician initial assessment, length of stay for discharges and for admission were 1h11min, 2h21min, and 6h29min, respectively. Generally, regional hospitals had shorter times than urban and academic/teaching hospitals. Conclusions Pediatric presentations to high volume emergency departments in this province suggest similar delays to see providers; however, length of stay for discharges and admissions were shorter in regional emergency departments. Crowding is more common in urban and especially academic emergency departments and the impact of crowding on patient outcomes requires further study.

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