• Ewout W Steyerberg, Henriëtte A Moll, Mirjam van Veen, Mariët Van't Klooster, Madelon Ruige, Alfred H J van Meurs, and Johan van der Lei.
• Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. h.a.moll@erasmusmc.nl
• Emerg Med J. 2012 Aug 1;29(8):654-9.

ObjectiveTo improve the Manchester Triage System (MTS) in paediatric emergency care.MethodsThe authors performed a prospective observational study at the emergency departments of a university and teaching hospital in The Netherlands and included children attending in 2007 and 2008. The authors developed and implemented specific age-dependent modifications for the MTS, based on patient groups where the system's performance was low. Nurses applied the modified system in 11,481 (84%) patients. The reference standard for urgency defined five levels based on a combination of vital signs at presentation, potentially life-threatening conditions, diagnostic resources, therapeutic interventions and follow-up. The reference standard for urgency was previously defined and available in 11,260/11,481 (96%) patients.ResultsCompared with the original MTS specificity improved from 79% (95% CI 79% to 80%) to 87% (95% CI 86% to 87%) while sensitivity remained similar ((63%, 95% CI 59% to 66%) vs (64%, 95% CI 60% to 68%)). The diagnostic OR increased (4.1 vs 11).ConclusionsModifications of the MTS for paediatric emergency care resulted in an improved specificity while sensitivity remained unchanged. Further research should focus on the improvement of sensitivity.

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