Evaluation of the Manchester triage system for patients with acute coronary syndrome

Abstract

Background An early diagnosis of acute coronary syndrome (ACS) is crucial for treatment and prognosis. The aim of this study was to evaluate the Manchester triage system (MTS) for patients with ACS, e.g. ST-segment elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (N-STEMI) and unstable angina pectoris (UAP). Methods Retrospective analysis of patients diagnosed with ACS (STEMI, N-STEMI and UAP) who were triaged in the emergency department (ED) with the MTS. Results In this study 282 patients with ACS (STEMI: 34.0%, N-STEMI: 61.7%, UAP: 4.3%) were triaged as MTS level 1 (immediate assessment): 0.4%, MTS level 2 (very urgent): 51.4%, MTS level 3 (urgent): 41.5%, MTS level 4 (standard): 6.7%, MTS level 5 (non-urgent): 0%. We observed significantly lower mean MTS levels in males (male: 2.48 ± 0.59, female: 2.68 ± 0.68, p = 0.02) and in patients younger than 80 years (age <80 years: 2.50 ± 0.61, age ≥80 years: 2.70 ± 0.67, p = 0.03). We did not find a significant difference of mean MTS levels in different types of ACS (STEMI: 2.46 ± 0.6, N-STEMI: 2.59 ± 0.64, STEMI

Factors that influence care priority for chest pain patients using the manchester triage system

“…Regarding the significant high percentage of these patients, who were assigned lower levels of priority (53.4%), it is worth mentioning that other studies showing lower percentage of patients being assigned lower levels of priority (from 27%–16.7%) did not exclude patients arriving to the emergency department on an ambulance, which may have influenced the number of patients who were assigned high priority of care (Gouvêa, Reis, Gouvêa, Lima, & Abuabara, ; Leite et al., ; Matias et al., ; Providência et al., ). This hypothesis is confirmed by the results of two other studies, one of them conducted only with patients going primarily to the emergency room, and which, similar to our study, showed that almost half of the patients (43.9%) with acute coronary syndrome were assigned lower priority based on MTS (Kiblböck et al., ). The second study compared how MI patients had arrived at the hospital and showed that those who had arrived by themselves had greater chances to be affected by reduced triage accuracy compared to those who had arrived on an ambulance (Atzema et al., ).…”

“…High blood pressure and smoking were the most common cardiovascular risk factors, confirming the results of other studies (Zornoff et al., ; Muller Rabelo, Moraes, & Azzolin, ). However, the presence of these risk factors did not influence care priority levels, as described in other studies (Kiblböck et al., ; Trigo et al., ), even though a low number of comorbidities have been reported to be associated with reduced triage accuracy (Atzema et al., ). Nevertheless, although it is widely known that the presence of such risk factors does not help diagnose a MI case (Body, McDowell, Carley, & Mackway‐Jones, ), it is understood that investigating these risk factors can be a valid strategy during triage, especially to identify individuals at risk of a cardiovascular event with atypical manifestation (Piegas et al., ).…”

“…These characteristics are aligned with the data described in other studies conducted with MI patients (Atzema et al., ; Zornoff et al., ; Ferraz‐Torres, Belzunegui‐Otano, Marín‐Fernandez, Martinez‐Garcia & Ibañez‐Beroiz, 2015). These characteristics were not significant when both priority groups (high priority and low priority) were compared (Kiblböck et al., ; Matias et al., ; Trigo et al., ). However, guidelines about acute coronary syndrome management stress that women and older patients should be given special attention, as they are more prone to experience atypical MI manifestations (Piegas et al., ).…”

“…This situation occurs in Brazil's major emergency departments due to public health system fragility and reduced number of hospital vacancies destined to the Brazilian Public Health System (SUS), which interferes in the work process and in the healthcare service provided to the population, preventing that severe and acute patients receive proper care and generating an overburden to health professionals. These factors may contribute to reduced triage criteria and accuracy by triage nurses within MTS, affecting patient safety (Furtado, Araújo Júnior, & Cavalcanti, ; Garlet, Lima, Santos, & Marques, ; Kiblböck et al., ; Santos, Lima, Pestana, Garlet, & Erdmann, ; Tanccini, ).…”

E-Triage Systems for COVID-19 Outbreak: Review and Recommendations

“…Moreover, we recommend adding a third category that represents those with little to no symptoms that are major or common for COVID-19. Figure 12 shows the suggested categories along with the possible scoring approach adapted from MOH [ 38 ] presented in Figure 7 .…”