Validity and Reliability of the Manchester Scale Used in the Orthopedic Emergency Department

Abstract

Objectives:To describe the clinical utility of the Manchester triage scale adapted for orthopedic emergency departments and to evaluate its validity in identifying patients with the need for hospital care and its reliability when reproduced by different professionals.Methods:Five triage flowcharts were developed based on the Manchester scale for the following orthopedic disorders: traumatic injuries, joint pain, vertebral pain, postoperative disorders, and musculoskeletal infections. A series of patients triaged by two orthopedists was analyzed to assess the concordance between the evaluators (reliability) and the validity of the Manchester scale as predictive of severity.Results:The reliability analysis included 231 patients, with an inter-observer agreement of 84% (Kappa = 0.77, p <0.001). The validity analysis included 138 patients. The risk category had a strong association with the need for hospital care in patients with trauma (OR = 6.57, p = 0.001) and was not significant for non-traumatic disorders (OR = 2.42; p = 0.208). The overall sensitivity and specificity were 64% and 76%, respectively.Conclusion:The evaluated system presented high reliability. Its validity was adequate, with good sensitivity for identifying patients requiring hospital care among those with traumatic lesions. However, the sensitivity was low for patients with non-traumatic lesions. Level of Evidence III, Retrospective Study.

The Reliability and Accuracy of International Triage Scale in the Emergency Department (ED): A Literature Review

“…The results of the review in 3 studies employing MTS with sample size (n = 412) which were divided into 398 direct triaged patients and 14 case scenarios presented the reliability of MTS was at good to excellent levels (k= 0.61 -0.95) (Olofsson, Gellerstedt, & Carlström, 2009;Gräff, Goldschmidt, Glien, Bogdanow, Fimmers, & Hoeft, et al, 2014;Andrade-Silva, Takemura, Bellato, Leonhardt, & Kojima, et al, 2019). While in 2 studies with sample size (n = 245) which were divided into 231 direct triaged patients and 14 triage case scenarios presented MTS accuracy was 64% -73%.…”

“…While in 2 studies with sample size (n = 245) which were divided into 231 direct triaged patients and 14 triage case scenarios presented MTS accuracy was 64% -73%. One study with sample size (n = 14 case scenarios) determines the percentage of under and over triage on MTS were 13% and 14% respectively (Olofsson, Gellerstedt, & Carlström, 2009;Andrade-Silva, Takemura, Bellato, Leonhardt, & Kojima, et al, 2019). While 1 other study with a sample size (n = 231) presented over triage in MTS occurred in 38% of traumatic patients and 69% in non-traumatic patients.…”

“…Triage is defined as a rapid process of categorizing patients upon arrival to determine priorities for further evaluation and treatment (Gräff, Goldschmidt, Glien, Bogdanow, Fimmers, & Hoeft, et al, 2014;Saeed, Al-Fayyadh, Alshomar, Zekry, & Alamiri, et al, 2017). Most of the triage systems applied in the ED are based on a five-level triage where this triage system has been conferred to improve the patient care outcomes historically (Andrade-Silva, Takemura, Bellato, Leonhardt, & Kojima, et al, 2019;Ekins & Morphet, 2015). There are variations in the application of triage systems that are tailored to the availability of resources, the economic situation, and the capacity of patients in each EDs in the wide world (Saeed, Al-Fayyadh, Alshomar, Zekry, & Alamiri, et al, 2017).…”

“…A triage system with five levels of urgency categories is the most widely adopted triage and published in various literature. The triage includes the Canadian Triage and Accuracy Scale (CTAS), the Australasian Triage Scale (ATS), the Manchester Triage System (MTS), and the Emergency Severity Index (ESI) (Andrade-Silva, Takemura, Bellato, Leonhardt, & Kojima, et al , 2019;Hinson, Martinez, Schmitz, Toerper, & Radu, et al, 2018).…”

Identifying a Clinical Risk Triage Score for Adult Emergency Department

“…Therefore, the reliability and validity of these systems are influenced by numerous factors, including illness severity, bed availability, and nurses' experiences (Chang et al, 2016). Some reviews indicate that these triage scales exhibit moderate inter-rater agreement and validity regarding acute mortality and hospitalization rates (Andrade-Silva et al, 2019;Parenti et al, 2014).…”