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- Intensive Care Units
Journal Article > Study
Safety of the Manchester Triage System to detect critically ill children at the emergency department.
Zachariasse JM, Kuiper JW, de Hoog M, Moll HA, van Veen M. J Pediatr. 2016;177:232-237.
Emergency department triage systems are designed to prioritize patients based on the level of illness. Inappropriate triage can lead to delays in care and adverse events. In Europe, the Manchester Triage System is a widely used algorithm that classifies patients based on five levels of urgency with a corresponding maximum waiting time. This study sought to assess the effectiveness of the Manchester Triage System in children requiring admission to the intensive care unit (ICU). Analyzing more than 50,000 consecutive emergency department visits of children younger than 16, the authors determined that almost one third of children admitted to the ICU were undertriaged. Risk factors identified for undertriage included age younger than 3 months, type of medical presenting problem, presence of underlying chronic conditions, referral by a specialist or emergency medical services, and arrival during the evening or at night. These findings suggest that the Manchester Triage System inappropriately triages a significant proportion of children requiring ICU admission and that modifications should be made to improve safety in pediatric emergency care. A previous WebM&M commentary discussed the challenges of triage in the emergency department.
Journal Article > Study
Early prognostic value of the medical emergency team calling criteria in patients admitted to intensive care from the emergency department.
Etter R, Ludwig R, Lersch F, Takala J, Merz TM. Crit Care Med. 2008;36:775-781.
Journal Article > Review
Ranji SR, Auerbach AD, Hurd CJ, O'Rourke K, Shojania KG. J Hosp Med. 2007;2:422-432.
Rapid response systems (RSS) have been widely endorsed and implemented, but controversy remains regarding their benefit on clinical outcomes. This systematic review of 13 published studies found no overall benefit of RRS on inpatient mortality, cardiac arrests, or unanticipated intensive care unit transfer. As noted in a prior commentary, most published studies had significant methodologic problems that limited their generalizability. While some more recent single-center studies of RRS have achieved impressive results, the authors of this review call for further research into the effectiveness of specific RRS models and the patient populations that may benefit most from RRS availability.