The Manchester Triage System (MTS): a score for emergency management of patients with acute gastrointestinal bleeding

Abstract

Background Suspected gastrointestinal (GI) bleeding is a common initial diagnosis in emergency departments. Despite existing endoscopic scores to estimate the risk of GI bleeding, the primary clinical assessment of urgency can remain challenging. The 5-step Manchester Triage System (MTS) is a validated score that is often applied for the initial assessment of patients presenting in emergency departments.

Methods All computer-based records of patients who were admitted between January 2014 and December 2014 to our emergency department in a tertiary referral hospital were analyzed retrospectively. The aim of our retrospective analysis was to determine if patient triage using the MTS is associated with rates of endoscopy and with presence of active GI bleeding.

Results In summary, 5689 patients with a GI condition were treated at our emergency department. Two hundred eighty-four patients (4.9 %) presented with suspected GI bleeding, and 165 patients (58 %) received endoscopic diagnostic. Endoscopic intervention for hemostasis was needed in 34 patients (21 %). In patients who underwent emergency endoscopy, triage into MTS categories with higher urgency was associated with higher rates of endoscopic confirmation of suspected GI bleeding (79 % of patients with MTS priority levels 1 or 2, 53 % in level 3 patients, and 40 % in levels 4 or 5 patients; p = 0.024).

Conclusions The MTS is an established tool for triage in emergency departments and could have a potential to guide early clinical decision-making with regards to urgency of endoscopic evaluation in patients with suspected GI bleeding.

Zusammenfassung

Hintergrund Eine gastrointestinale Blutung ist eine der häufigsten gastroenterologischen Verdachtsdiagnosen in einer Notaufnahme. Obwohl diverse Scores zur Einschätzung der schwere einer gastrointestinalen Blutung existieren, kann die primäre notfallmedizinische Einschätzung dieser Patienten dennoch herausfordernd sein. Das Manchester Triage System (MTS) ist ein validierter Score, der für Patienten unabhängig von diagnostischen Befunden zur Triage bei der initialen Aufnahme in einer Notaufnahme von nicht ärztlichem Personal angewandt wird.

Methoden Alle Akten von gastroenterologischen Patienten die zwischen Januar 2014 und Dezember 2014 in unserer Notaufnahme eines Maximalversorgers behandelt wurden, wurden retrospektiv analysiert. Das Ziel unserer retrospektiven Analyse war es zu untersuchen, ob die Anwendung des MTS mit der endoskopischen Diagnostik und dem Befund einer aktiven gastrointestinalen Blutung korreliert.

Ergebnisse Insgesamt wurden 5689 Patienten in einem Jahr mit einer gastrointestinalen Symptomatik in unserer Notaufnahme behandelt. Bei 284 Patienten (4,9 %) wurde eine gastrointestinale Blutung vermutet. 165 Patienten (58 %) erhielten akut oder im Verlauf eine endoskopische Diagnostik. Dabei war eine endoskopische Intervention bei 34 Patienten (21 %) notwendig. Patienten die in höheren MTS Notfallkategorien klassifiziert waren, zeigten höhere Raten an endoskopisch bestätigten gastrointestinalen Blutungen. (79 % mit MTS Level 1 oder 2, 53 % in Level 3 und 40 % in Level 4 oder 5; p = 0,024).

Schlussfolgerung Das MTS ist ein etabliertes Triage System in Notaufnahmen. Es kann angenommen werden, dass dieses einfach zu bedienende System auch das Potential hat, klinische Entscheidungen für eine Notfallendoskopie bei Patienten mit dem Verdacht auf eine gastrointestinale Blutung zu unterstützen.

Key words

gastrointestinal bleeding - GI hemorrhage - Manchester Triage System (MTS) - endoscopy - bleeding risk

Schlüsselwörter

Gastrointestinale Blutung - Manchester Triage System (MTS) - Endoskopie - Blutungsrisiko

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