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Philipp Schondelmaier1, Anna Slagman1, Martin Möckel1, Antje Fischer-Rosinský1, Konrad Reinhart1, Catalina De La Cruz Macias1, Angelika Stacke2, Johannes Winning2, Michael Bauer2, Myrto Bolanaki1
Objectives.
To meet the requirement of the Sepsis-3 guidelines for rapid initiation of treatment, emergency department (ED) triage systems must assign patients with suspected sepsis to the highest-priority triage categories. Our aim was to explore how effectively the Manchester Triage System (MTS) and the Emergency Severity Index (ESI) assign these patients to appropriate urgency categories and avoid undertriage.
Methods.
A secondary analysis was conducted from a prospective, multicenter observational study (LIFE-POC), which included patients presenting with suspected organ dysfunction in 1 of 3 participant EDs (2 using MTS and 1 using ESI). The primary endpoint was a diagnosis of sepsis within 24 hours of ED presentation. Patients diagnosed with sepsis who were assigned to urgent triage categories 1, 2, or 3 were classified as accurately triaged. Ethical approval was granted by the committees of the participating centers.
Results.
A total of 388 out of 1,424 patients were diagnosed with sepsis within 24 hours of ED presentation. MTS showed a sensitivity rate of 88.2% (undertriage, 11.8%), while ESI reached 99.0% (undertriage, 1.0%). Both triage tools demonstrated low specificity: 17.5% (MTS) and 2.7% (ESI). Binary logistic regression analysis indicated that the probability of sepsis increased with higher urgency triage categories and decreased in lower urgency categories.
Conclusions.
Both ESI and MTS demonstrated high sensitivity in assigning septic patients to higher urgency categories, with better performance by ESI. However, MTS showed superior discrimination between urgency levels and may therefore be more compatible with the resource limitations typically encountered in EDs.
