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Amirhossein Mirafzal1 
, Arman Khajoue1 , Mehdi Torabi *2 , Sara Azizi Shoul1 , Ahmad Naghibzadeh-Tahami3
, Arman Khajoue1 , Mehdi Torabi *2 , Sara Azizi Shoul1 , Ahmad Naghibzadeh-Tahami3
1- Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran.
2- Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran. ,mtorabi1390@yahoo.com
3- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
2- Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran. ,
3- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Abstract: (31 Views)
Background: This study compares the Emergency Severity Index (ESI) and Manchester Triage System (MTS), focusing on their correlation with the Injury Severity Score (ISS) and outcomes in trauma patients.
Materials and Methods: In this cross-sectional observational study with prospective patient inclusion and dual real-time triage, 400 trauma patients were triaged using the ESI by five experienced hospital triage nurses as part of routine care and using the MTS by five separate skilled emergency nurses trained specifically for this study in the emergency department (ED) of an Academic Hospital, a level II trauma center from March 1, 2024, to June 1, 2024. Because each patient received both triage classifications, paired statistical methods were used for all direct comparisons between the two systems. Triage levels from the two systems were compared with each other and with the ISS. Secondary outcomes included hospitalization, discharge within 24 hours, mortality, and length of stay (LOS).
Results: The MTS and ESI showed moderate correlation (ρ = 0.352, 95% CI: 0.262–0.435, p < 0.001). Increasing triage severity levels in both systems were moderately associated with higher ISS and longer LOS (p < 0.001). At non-emergency levels, both systems had similar rates of patients discharged within the first 24 hours (MTS: 80.7%; ESI: 80.6%). However, the proportion of patients classified as emergent was lower with MTS (Orange/Red: 5.5%,95% CI: 3.6–8.2) compared with ESI (Levels 1/2: 8.5%, 95% CI: 6.1–11.7%) (p=0.008), with emergent patients in both systems showing high hospitalization rates (MTS: 78.95%–100%; ESI: 53.33%–75%). The mortality rate was identical (0.5%) for both triage systems. Both triage systems showed similar moderate-to-large correlations with ISS and LOS. Over-triage rates were higher with ESI (6.5%, 95% CI: 4.5–9.3%) than MTS (3.0%, 95% CI: 1.7–5.2%) (p=0.01), while under-triage rates were similar (ESI 14.1%, 95% CI: 9.7–20.1% vs. MTS 15.0%, 95% CI: 10.4–21.2%; p=0.62).
Conclusion: The ESI and MTS exhibited similar performance and a positive correlation with outcomes for trauma patients. Increased severity in both systems was significantly associated with higher ISS and longer LOS. Both systems showed comparable proportions of non-emergency patients discharged, with the ESI classifying more patients as emergent. ESI exhibited a tendency to over-triage relative to MTS, while under-triage rates remained comparable. MTS may offer higher specificity, although this is confounded by study design.
Materials and Methods: In this cross-sectional observational study with prospective patient inclusion and dual real-time triage, 400 trauma patients were triaged using the ESI by five experienced hospital triage nurses as part of routine care and using the MTS by five separate skilled emergency nurses trained specifically for this study in the emergency department (ED) of an Academic Hospital, a level II trauma center from March 1, 2024, to June 1, 2024. Because each patient received both triage classifications, paired statistical methods were used for all direct comparisons between the two systems. Triage levels from the two systems were compared with each other and with the ISS. Secondary outcomes included hospitalization, discharge within 24 hours, mortality, and length of stay (LOS).
Results: The MTS and ESI showed moderate correlation (ρ = 0.352, 95% CI: 0.262–0.435, p < 0.001). Increasing triage severity levels in both systems were moderately associated with higher ISS and longer LOS (p < 0.001). At non-emergency levels, both systems had similar rates of patients discharged within the first 24 hours (MTS: 80.7%; ESI: 80.6%). However, the proportion of patients classified as emergent was lower with MTS (Orange/Red: 5.5%,95% CI: 3.6–8.2) compared with ESI (Levels 1/2: 8.5%, 95% CI: 6.1–11.7%) (p=0.008), with emergent patients in both systems showing high hospitalization rates (MTS: 78.95%–100%; ESI: 53.33%–75%). The mortality rate was identical (0.5%) for both triage systems. Both triage systems showed similar moderate-to-large correlations with ISS and LOS. Over-triage rates were higher with ESI (6.5%, 95% CI: 4.5–9.3%) than MTS (3.0%, 95% CI: 1.7–5.2%) (p=0.01), while under-triage rates were similar (ESI 14.1%, 95% CI: 9.7–20.1% vs. MTS 15.0%, 95% CI: 10.4–21.2%; p=0.62).
Conclusion: The ESI and MTS exhibited similar performance and a positive correlation with outcomes for trauma patients. Increased severity in both systems was significantly associated with higher ISS and longer LOS. Both systems showed comparable proportions of non-emergency patients discharged, with the ESI classifying more patients as emergent. ESI exhibited a tendency to over-triage relative to MTS, while under-triage rates remained comparable. MTS may offer higher specificity, although this is confounded by study design.
Keywords: Emergency Severity Index, Injury Severity Score, Manchester Triage System, Trauma, Emergency Department, Triage Systems
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This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-By-NC), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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