The “mass casualty” flow chart of the Manchester Triage System: A prospective investigation in traumatological and non-traumatological patients

Abstract

Background: For clinical triage in the emergency department (ED), there has been no standardized triage algorithm for mass casualty incidents. With the release of the fourth revised and expanded edition of the Manchester Triage System (MTS), a special flow chart (“mass casualty”) is offered to the user. In the present study, the MTS mass casualty flow chart is examined for the first time in the clinical setting with regard to its quality. Methods: In the present monocentric, prospective study, 215 traumatological and 235 non-traumatological patients were screened using the mass casualty flow chart and grouped into one of the three triage categories (SK I–III). Results: The traumatology cohort was correctly classified by the MTS diagram in 80% of the cases. Over-triage occurred in 15.35% and under-triage in 4.65%. Here, a sensitivity/specificity of 84/99% for SKI, 87/78% for SKII, and 76/94% for SKIII was achieved. The non-traumatological patients were correctly categorized in 59.57% of the cases, over-triaged in 15.75%, and under-triaged in 24.68%. The sensitivity/specificity for SK I was 50/95%, for SK II 49/71%, and for SK III 73/65%. Discussion: In conclusion, the algorithm was easy and quick to use and accurately identified traumatological patients with life-threatening injuries. However, it also became clear that the discriminant “ability to walk” at the beginning of the triage or purely physiological decision criteria were associated with poor test quality. Non-traumatological clinical pictures were categorized with insufficient quality.