RT Journal Article
SR Electronic
T1 Can urgency classification of the Manchester triage system predict serious bacterial infections in febrile children?
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 715
OP 722
DO 10.1136/adc.2010.207845
VO 96
IS 8
A1 Ruud G Nijman
A1 Rob LJ Zwinkels
A1 Mirjam van Veen
A1 Ewout W Steyerberg
A1 Johan van der Lei
A1 Henriëtte A Moll
A1 Rianne Oostenbrink
YR 2011
UL http://adc.bmj.com/content/96/8/715.abstract
AB Objective To evaluate the discriminative ability of the Manchester triage system (MTS) to identify serious bacterial infections (SBIs) in children with fever in the emergency department (ED) and to study the association between predictors of SBI and discriminators of MTS urgency of care. Methods This prospective observational study included 1255 children with fever (1 month–16 years) attending the ED of the Erasmus MC – Sophia Children's Hospital, Rotterdam, The Netherlands in 2008–9. Triage urgency was determined with the MTS (urgency (U) level 1–5). The relationship between triage urgency and SBI was assessed with multivariable logistic regression, including effects of age, sex and temperature. Discriminative ability was assessed by receiver operating characteristic curve analysis. Results SBI prevalence was 11% (n=131, 95% CI 9% to 12%). The discriminative value of the MTS for predicting SBI was 0.57 (95% CI 0.52 to 0.62), and the MTS did not contribute to a model including age, sex and temperature. The sensitivity of the MTS (U1–2 vs U3–5) to detect SBI was 0.42 (95% CI 0.33 to 0.51) and specificity was 0.69 (95% CI 0.66 to 0.72). MTS high urgency discriminators include several known predictors of SBI, such as fever, work of breathing, meningism and oxygen saturation, but apply to non-SBI children as well. Conclusion The MTS has poor discriminative ability to predict the presence of SBIs in children presenting with fever to the paediatric ED. Important predictors of SBI are represented within the MTS, but are used in a different way to classify urgency.