Suitability of the German version of the Manchester Triage System to redirect emergency department patients to general practitioner care: a prospective cohort study
Suitability of the German version of the Manchester Triage System to redirect emergency department patients to general practitioner care: a prospective cohort study
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DOI：
10.1136/bmjopen-2018-024896
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发表时间：
2019-05-01
期刊：
影响因子：
2.9
通讯作者：
Moeckel, Martin
中科院分区：
文献类型：
--
作者：
Slagman, Anna;Greiner, Felix;Moeckel, Martin
目的探讨德国版本的曼彻斯特分诊系统（MTS）作为一个潜在的工具，以重新定向急诊科（艾德）患者全科医生护理的适用性。这些工具目前正在德国的急诊护理重组的背景下进行讨论。设计前瞻性队列研究。设置单中心大学医院急诊科。参与者成人，非手术艾德患者。暴露根据德国版MTS，非紧急分诊类别被定义为绿色或蓝色分诊类别。主要和次要结局指标短期风险的替代参数（入院率、诊断、住院时间、入住重症监护室、住院和30天死亡率）和长期风险（1年死亡率）。其中，31.9%（n= 358）接受了非紧急分诊类别，68.1%（n= 764）为紧急。与非紧急艾德表现相比，具有紧急分诊类别的患者年龄更大（中位年龄60岁vs 56岁，p= 0.001），更可能需要住院（47.8% vs 29.6%），住院死亡率更高（1.6% vs 0.8%）。在30天死亡率（1.2% [n= 4] vs 2.2% [n= 15]; p= 0.285）或1年死亡率（7.9% [n= 26] vs 10.5% [n= 72]; p= 0.190）方面，未观察到非紧急和紧急分诊类别之间的显著差异。在单变量中，紧迫性并不是1年死亡率的重要预测因素（HR= 1.35; 95% CI 0.87 - 2.12; p= 0.185）和多变量回归分析（HR= 1.20; 95% CI 0.77 - 1.89; p= 0.420）。结论本研究的结果表明，德国MTS是不适合安全地确定重定向到非ED为基础的GP护理的患者。
Objectives To investigate the suitability of the German version of the Manchester Triage System (MTS) as a potential tool to redirect emergency department (ED) patients to general practitioner care. Such tools are currently being discussed in the context of reorganisation of emergency care in Germany.Design Prospective cohort study.Setting Single centre University Hospital Emergency Department.Participants Adult, non-surgical ED patients.Exposure A non-urgent triage category was defined as a green or blue triage category according to the German version of the MTS.Primary and secondary outcome measures Surrogate parameters for short-term risk (admission rate, diagnoses, length of hospital stay, admission to the intensive care unit, in-hospital and 30-day mortality) and long-term risk (1-year mortality).Results A total of 1122 people presenting to the ED participated in the study. Of these, 31.9% (n= 358) received a non-urgent triage category and 68.1% (n= 764) were urgent. Compared with non-urgent ED presentations, those with an urgent triage category were older (median age 60 vs 56 years, p= 0.001), were more likely to require hospital admission (47.8% vs 29.6%) and had higher inhospital mortality (1.6% vs 0.8%). There was no significant difference observed between non-urgent and urgent triage categories for 30-day mortality (1.2% [n= 4] vs 2.2% [n= 15]; p= 0.285) or for 1-year mortality (7.9% [n= 26] vs 10.5% [n= 72]; p= 0.190). Urgency was not a significant predictor of 1-year mortality in univariate (HR= 1.35; 95% CI 0.87 to 2.12; p= 0.185) and multivariate regression analyses (HR= 1.20; 95% CI 0.77 to 1.89; p= 0.420).Conclusions The results of this study suggest the German MTS is unsuitable to safely identify patients for redirection to non-ED based GP care.