Manchester triage system in acute pulmonary embolism: can it predict the mortality?

Abstract

Purpose: Although common and often fatal, acute pulmonary embolism (PE) is difficult to diagnose and can be easily missed in a busy emergency room. Manchester triage system (MTS) prioritizes patients on the perception of illness severity and potentially recognizes those with higher mortality risk. The aim of this study was to assess the predictive value of MTS in mortality after acute PE. Methods: Retrospective, observational study including 204 patients (age 72.6±16.8; 98 males) with acute PE diagnosed by pulmonary CT angiography admitted to a tertiary hospital emergency department, between January 2010 and December 2010. The primary endpoint was all-cause in-hospital mortality. Secondary endpoint was all-cause mortality at 18-month follow-up. Results: Most patients were stratified as orange (n=110, 53.9%), followed by yellow (n=72, 35.3%), green (n=16, 7.8%) and red (n=6, 2.9%). In-hospital mortality was 10.3% and 18-month all-cause mortality was 10.8%. Patients stratified as red or orange had a significantly higher in-hospital mortality, compared with those with yellow or green levels of severity (16.4% vs. 2.3%, p<0.001). The all-cause mortality at 18-month follow-up was higher in red or orange patients but without statistical significance (14.4% vs. 9.4%, log rank p=0.27). (figur presented) Conclusions: Despite the non-specific clinical presentation of acute PE, the MTS accurately stratifies in-hospital mortality and therefore should be used in the emergency department.