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The following is a summary of “Reproducibility of the Manchester Triage System: a multicentre vignette study,” published in the March 2025 issue of Emergency Medicine Journal by Zaboli et al. 

Researchers conducted a retrospective study to examine the agreement between nurse-assigned and expert-assigned Manchester Triage System (MTS) codes and association with clinical outcomes.  

They analyzed data from January to March 2024 across 4 emergency departments (EDs) in Italy using the MTS and 2 emergency physicians developed 30 vignettes from real cases, covering various triage scenarios and priority codes. An expert MTS group of 3 experienced nurses was assigned MTS priority codes based on official guidelines. Triage nurses independently assigned MTS codes after reviewing the vignettes. Error rates, agreement between nurse-assigned and expert-assigned codes, and predictive accuracy for secondary clinical outcomes (mortality within 72 hours, hospitalization, life-saving intervention, severe ED conditions, and time-dependent pathology) were compared.  

The results showed that 77 nurses from 4 EDs participated. The triage code assignment error rate was 28.6% (660/2310). Agreement between triage and expert nurses had a Cohen’s kappa of 0.59 (95% CI 0.58 to 0.59). Expert MTS group codes more accurately predicted clinical outcomes than nurse-assigned codes. The mean error rate per nurse was 30% (9/30). Nurses with greater ED experience and triage expertise had higher error rates.  

Investigators concluded the application of the MTS using case vignettes was suboptimal, with senior nurses showing higher error rates, and that accurate MTS application improved outcome prediction. 

Source: emj.bmj.com/content/early/2025/03/06/emermed-2024-214213