Risk classification in an emergency room: agreement level between a Brazilian institutional and the Manchester Protocol

Abstract

The aim of this study was to assess the level of agreement between an institutional protocol and the Manchester protocol for the risk assessment of patients attended in an emergency room of a public hospital in Belo Horizonte -MG -Brazil. This is a descriptive and comparative study, in which 382 patients' reports were evaluated and the risk was classified, using the institutional protocol and the Manchester protocol. Rates were calculated through weighted and unweighted kappa, in order to determine the level of agreement between the protocols.The results showed that the correlation between the protocols is average when considering that classification errors occurred between neighboring colors (kappa=0.48), and good when considering that classification errors occurred between extreme colors (kappa=0.61).The Manchester protocol increased the patients' level of priority of patients and has been considered more inclusive. Clasificación de riesgo en primeros auxilios: concordancia entre un protocolo institucional brasileño y el de ManchesterEste estudio tuvo por objetivo verificar el grado de concordancia entre un protocolo institucional y el protocolo de Manchester para la clasificación de riesgo de pacientes atendidos en primeros auxilios de un hospital público de Belo Horizonte -MG -Brasil.Se trata de estudio descriptivo comparativo en el cual 382 fichas fueron evaluadas y, realizada la clasificación de riesgo utilizando los protocolos mencionados encima, a partir del registro realizado por los enfermeros. Índices kappa ponderado y no ponderado fueron calculados para determinar el grado de concordancia entre los protocolos.Los resultados mostraron que la concordancia entre los protocolos es media, cuando considerados los errores de clasificación ocurridos entre colores vecinos (kappa=0,48) y buena, cuando considerados los errores de clasificación ocurridos entre colores extremos (kappa=0,61). Se concluye que el protocolo de Manchester aumentó el nivel de prioridad de los pacientes, demostrando ser un protocolo que incluye más.

Sistema Manchester: tempo empregado na classificação de risco e prioridade para atendimento em uma emergência

“…Similarly, other studies (3,(11)(12)14,18,20) have already shown an association between priority attributed by the MTS and severity levels (18,20) , risk of remaining hospitalized (11)(12)18,20) , length of hospital stay (18) , and risk of death (11)(12)18,20) . One of these studies (18) proved that the mean of number of days of hospital stay decreased in the same order of complexity of patient status ( red, orange, yellow, and green).…”

Outcome assessment of patients classified through the Manchester Triage System in emergency units in Brazil and Portugal

“…(1) A study carried out in Brazil compared the MTS with an institutional classification system showing that the former is more inclusive and increases the priority level of the classified patients. (8) In a study carried out in Portugal, the MTS was useful to distinguish patients who needed emergency care from the others. (9) Brazil and Portugal have similar health services; in both, the health system is controlled by the State, is ruled laws of the Federal Constitution and is under the responsibility of the Ministry of Health.…”

Relationship between risk stratification, mortality and length of stay in a Emergency Hospital

“…Research has shown that the system has been well adapted to the Brazilian reality, but that validation studies are needed because it is new technology in the implementation phase within the country. 8 Another Brazilian study established the predictive validity of the MTS deployed at the entrance door of an urgent service in Belo Horizonte, MG. This study also utilized the Therapeutic Intervention Scoring System -28 (TISS -28) to measure the severity of patients after 24 hours of admission to the ED.…”