https://doi.org/10.4081/ecj.2025.13269
An alternative perspective on triage systems: the Progressive Real-world Optimization of Triage System (PROGRESS) study
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Published: 27 February 2025
Triage systems have remained largely unchanged since the 1990s and rely on expert consensus, with no single system consistently outperforming others in accurately identifying critically ill or urgent patients. This study aimed to determine whether incorporating additional tools improves the predictive accuracy of the Manchester Triage System (MTS). A prospective, monocentric study was conducted at Merano Hospital (Italy) from June 1st to December 31st, 2023. A triage nurse and two ED physicians assigned patient priorities. The cohort was split for model derivation and validation. An ordinal logistic regression model was developed using MTS, the National Early Warning Score, and the Charlson Comorbidity Index, then tested on a validation cohort, bootstrapped to 5000 cases. Of the 1270 patients enrolled, 821 were in the derivation cohort and 449 in the validation cohort. The model outperformed MTS alone in most outcomes, except for predicting death at 72 hours and 7 days. Decision Curve Analysis confirmed its superiority in identifying urgent cases. Integrating multiple tools into triage models can enhance their performance, improving patient prioritization accuracy.
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Tam HL, Chung SF, Lou CK. A review of triage accuracy and future direction. BMC Emerg Med. 2018;18:58.
Estrada EG. Triage systems. Nurs Clin North Am 1981;16:13-24.
González J, Soltero R. Emergency Severity Index (ESI) triage algorithm: trends after implementation in the emergency department. Bol Asoc Med P R 2009;101:7-10.
Mackaway-Jones K, Marsden J, Windle J. Emergency Triage: Manchester triage group, Third edition. John Wiley & Sons, Ltd, West Sussex. 2014.
Azeredo TR, Guedes HM, Rebelo de Almeida RA, Chianca TC, Martins JC. Efficacy of the Manchester Triage System: a systematic review. Int Emerg Nurs 2015;23:47-52.
Kuriyama A, Urushidani S, Nakayama T. Five-level emergency triage systems: variation in assessment of validity. Emerg Med J 2017;34:703-710.
Hinson JS, Martinez DA, Cabral S, et al. Triage Performance in Emergency Medicine: A Systematic Review. Ann Emerg Med 2019;74:140-152.
Zachariasse JM, van der Hagen V, Seiger N, et al. Performance of triage systems in emergency care: a systematic review and meta-analysis. BMJ Open 2019;9:e026471.
Fehlmann CA, Nickel CH, Cino E, et al. Frailty assessment in emergency medicine using the Clinical Frailty Scale: a scoping review. Intern Emerg Med 2022;17:2407-2418.
Zaboli A, Brigo F, Sibilio S, et al. The impact of COVID-19 pandemic on the urgency of patients admitted to the emergency department. Int Emerg Nurs 2022;65:101229.
van Dam CS, Labuschagne HA, van Keulen K, et al. Polypharmacy, comorbidity and frailty: a complex interplay in older patients at the emergency department. Eur Geriatr Med 2022;13:849-57.
Elliott A, Taub N, Banerjee J, et al. Does the clinical frailty scale at triage predict outcomes from emergency care for older people? Ann Emerg Med 2021;77:620-7.
Rashiti P, Rashiti-Bytyçi A, Haradinaj K, et al. Using the HEART score in patients with chest pain in the emergency department of Kosovo as an important triage criterion for treatment and hospitalization. Ann Med Surg (Lond) 2023;85:3318-22.
Zaboli A, Sibilio S, Cipriano A, et al. Italian validation of the Manchester Triage System towards short-term mortality: a prospective observational study. Emerg Care J 2023;19:11443
Platts-Mills TF, Travers D, Biese K, et al. Accuracy of the Emergency Severity Index triage instrument for identifying elder emergency department patients receiving an immediate life-saving intervention. Acad Emerg Med 2010;17:238-43.
Zachariasse JM, Seiger N, Rood PP, et al. Validity of the Manchester Triage System in emergency care: A prospective observational study. PLoS One 2017;12:e0170811.
Zaboli A, Ausserhofer D, Sibilio S, et al. Effect of the emergency department assessment of chest pain score on the triage performance in patients with chest pain. Am J Cardiol 2021;161:12-18.
Raita Y, Goto T, Faridi MK, et al. Emergency department triage prediction of clinical outcomes using machine learning models. Crit Care 2019;23:64.
Zachariasse JM, Maconochie IK, Nijman RG, et al. Improving the prioritization of children at the emergency department: Updating the Manchester Triage System using vital signs. PLoS One 2021;16:e0246324.
Cooper RJ, Schriger DL, Flaherty HL, et al. Effect of vital signs on triage decisions. Ann Emerg Med 2002;39:223-32.
Pellerin G, Gao K, Kaminsky L. Predicting 72-hour emergency department revisits. Am J Emerg Med 2018;36:420-4.
Usman OA, Usman AA, Ward MA. Comparison of SIRS, qSOFA, and NEWS for the early identification of sepsis in the Emergency Department. Am J Emerg Med 2019;37:1490-7.
Almutary A, Althunayyan S, Alenazi K, et al. National Early Warning Score (NEWS) as prognostic triage tool for septic patients. Infect Drug Resist 2020;13:3843-51.
Challen K. How good is triage, and what is it good for? Emerg Med J 2017;34:702.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-83.
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