The Manchester triage system is used in emergency departments to determine the clinical priority of patients on the basis of their presenting features.1 It is not a diagnostic based system but ascribes a time by which ideally each patient should be seen by a clinician. It therefore functions as a risk management tool and can also be used to monitor overall activity in the emergency department. It is widely used in the United Kingdom and Europe. In the linked study (doi:10.1136/bmj.a1501), Van Veen and colleagues assess the validity of this system in 17 600 children visiting an emergency department in the Netherlands in 2006-7.2

Using this system, experienced clinicians, such as emergency department nurses, assess patients on the basis of the available history and, by means of focused questioning, choose one of 52 flow pathways. The sequential questions delineate the risk and hence the time in which the patient …