Manchester Triage in Sweden - interrater reliability and accuracy

This study investigates the interrater reliability and the accuracy of Manchester Triage (MTS) at emergency departments in Western Sweden.

A group of 79 nurses from seven emergency departments assessed simulated patient cases and assigned triage categories using the same principles as in their daily work. K statistics, accuracy, over-triage and under-triage were then analyzed. The nurses performed 1027 triage assessments.

The result showed an unweighted kappa value of 0.61, a linear weighted kappa value of 0.71, and a quadratic weighted kappa value of 0.81. The determined accuracy was 92% and 91% for the two most urgent categories, but significantly lower for the less urgent categories.

Patients in need of urgent care were identified in more than nine out of 10 cases. The high level of over-triage and under-triage in the less urgent categories resulted in low agreement and accuracy. This may suggest that the resources of emergency departments can be overused for non-urgent patients.