Triage of patients with fever: The Manchester triage system's predictive validity for sepsis or septic shock and seven-day mortality

• Published in: Journal of critical care 2020-10, Vol.59, p.63-69
• Main Authors: Zaboli, Arian, Ausserhofer, Dietmar, Pfeifer, Norbert, Solazzo, Pasquale, Magnarelli, Gabriele, Siller, Marianne, Turcato, Gianni
• Format: Article
• Language: English
• Subjects: Adult; Aged; Audits; Codes; Critical care; Emergency department; Emergency Service, Hospital; Female; Fever; Fever - diagnosis; Fever - mortality; Hospitalization; Humans; Male; Manchester triage system; Middle Aged; Mortality; Nursing; Patients; Predictive Value of Tests; Prognosis; Retrospective Studies; Sensitivity and Specificity; Sepsis; Septic shock; Severity of Illness Index; Shock, Septic - diagnosis; Shock, Septic - mortality; Triage; Triage - methods; Validity
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2020.05.019

Up to 15% of patients arrive in the emergency department suffering from fever. Triage is their first contact and is responsible for the stratification of patients according to the severity of the condition for which they are presenting at the emergency department. The aim of this study is to assess the predictive validity of the Manchester Triage System in patients with fever for sepsis or septic shock and seven-day mortality. The sensitivity, specificity and negative predictive value of the Manchester Triage System was assessed by priority code allocation towards seven-day mortality and the diagnosis of sepsis or septic shock. A total of 3831 patients were evaluated in the emergency department for fever between 1 January 2017 and 30 June 2019. Of these, 1.9% were diagnosed with sepsis or septic shock. Using the Manchester Triage System to predict diagnosis of sepsis or septic shock provided a sensitivity of 88.7%, a specificity of 50.1% and a negative predictive value of 99.5%. For seven-day mortality, sensitivity was 44.4%, specificity was 92.3% and the negative predictive value was 99.3%. The Manchester Triage System has demonstrated high sensitivity and negative predictive value in patients with fever diagnosed with sepsis or septic shock. For patients with sepsis or septic shock one-third of cases with an incorrectly assigned priority code were caused by incorrect application of the Manchester Triage System. •MTS has demonstrated a high sensitivity towards patients with sepsis.•MTS revealed high specificity in patients with fever towards death at seven days.•33% of under triage in sepsis patients was caused by poor application of MTS.•MTS does not present a dedicated diagram for the evaluation of patients with fever.