Triage system underperforms in children with chronic illness

(HealthDay)—For children presenting to the emergency department with infectious symptoms, performance of the Manchester Triage System (MTS) is lower for those with chronic illnesses, compared to those without chronic illnesses, according to a study published online Nov. 4 in Pediatrics.

Nienke Seiger, M.D., from the University Medical Center Rotterdam in the Netherlands, and colleagues assessed the validity of the MTS for children with chronic illnesses using data from 8,592 children <16 years old who presented to the emergency department between 2008 and 2011 with infectious symptoms (dyspnea, diarrhea/vomiting, or fever). The urgency categories of the MTS were compared with an independent reference standard on the basis of abnormal vital signs, life-threatening working diagnosis, resource utilization, and follow-up.

The researchers found that 35 percent of those who presented to the emergency department with infectious symptoms had a chronic illness. Undertriage occurred in significantly more children with chronic illnesses (16 percent) than in those without chronic illnesses (11 percent; P < 0.001). For children with chronic illnesses, the MTS had a sensitivity of 58 percent, compared with 74 percent for children without chronic illnesses. Specificity did not differ between the groups. For children with and without chronic illnesses, the diagnostic odds ratios were 4.8 and 8.7, respectively.

"Nurses should be particularly aware of undertriage in children with chronic illnesses," the authors write.

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