Article Text

Download PDFPDF
Safety of the Manchester Triage System to identify less urgent patients in paediatric emergence care: a prospective observational study
  1. Mirjam van Veen1,
  2. Ewout W Steyerberg2,
  3. Lizanne Lettinga1,
  4. Madelon Ruige3,
  5. Alfred H J van Meurs3,
  6. Johan van der Lei4,
  7. Henriëtte A Moll1
  1. 1Department of General Paediatrics, Erasmus MC–Sophia Children's Hospital, Rotterdam, The Netherlands
  2. 2Center for Medical Decision Making, Public Health, Erasmus MC, Rotterdam, The Netherlands
  3. 3Department of Paediatrics, Haga Hospital, Juliana Children's Hospital, The Hague, The Netherlands
  4. 4Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Henriëtte A Moll, Department of General Paediatrics, Room Sp 1540, Erasmus MC–Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands; h.a.moll{at}


Objective To assess hospitalisation rate as a proxy for the ability of the Manchester Triage System (MTS) to identify less urgent paediatric patients. We also evaluated general practitioner (GP) services to determine if they met patients' needs compared to emergency department care.

Methods Self-referred children triaged as less urgent by the MTS in two emergency departments in the Netherlands were included in a prospective observational study. Therapeutic interventions during emergency department consultation, hospitalisation after consultation and determinants for hospitalisation were assessed using logistic regression analysis.

Results During emergency department consultation, extensive therapeutic interventions were performed more often in patients with extremity problems (n=175, 19%) and dyspnoea (n=30, 15%). 191 (3.5%) of 5425 patients were hospitalised. Age and presenting problem remained statistically significant in multivariable logistic analysis, predicting hospitalisation with ORs of 3.0 (95% CI 2.2 to 4.1) for age <1 year, 2.5 (1.5 to 4.1) for dyspnoea, 3.5 (2.5 to 4.9) for gastrointestinal problems and 2.8 (1.1 to 7.2) for patients with fever without identified source compared to all other patients. 3975 (76%) of 5234 patients were contacted for follow-up after discharge. Six (0.15%) patients were hospitalised after emergency department discharge.

Conclusion In the MTS less urgent categories, overall hospitalisation is low, although children <1 year of age or with dyspnoea, gastrointestinal problems or fever without identified source have an increased risk for hospitalisation. Except for these patient groups, the MTS identifies less urgent patients safely. It may not be optimal for GP services to treat patients with extremity problems.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This study was funded by the Netherlands Organization for Health Research and Development (ZonMw) and Erasmus MC, Rotterdam, The Netherlands.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of Erasmus MC, Rotterdam, The Netherlands.

  • Provenance and peer review Not commissioned; externally peer reviewed.