Neither the Van Veen paper nor the accompanying editorial appeared to
be aware of the Australasian work that produced the first published five-
point triage scale in 1993 (Australasian College for Emergency Medicine).
Following a study of over 11,000 occasions of triage by Whitby et al, a
groupd of clinical descriptors was linked to the scale, and it was updated
and published as the Australasian Triage Scale (ATS) in 2000. The
descriptors can be found at http://www.acem.org.au/media/policies_and_guidelines/G24_Implementation_...,
with an accompanying paper at http://www.acem.org.au/media/policies_and_guidelines/G24_Implementation_....
This work formed the basis of subsequent five-point scales, including
both Manchester and CTAS. The clinical descriptors were found to be
significantly correlated with the categories. There are specific
descriptors for paediatric presentations. Although it has proven
impossible to show that triage categorisation affects clinical outcome
(because of the difficulty in controlling - or even knowing - the time of
onset), the categories have been shown to correlate with admission rates
to hospital.
It is puzzling to see a study that attempts to validate the
Manchester scale against the standard of a local, less-validated scale,
and puzzling that the standard was not precisely described in the
published study. Can the authors give us more information about their
standard and how it was derived? How has the local standard been
validated?
The main purpose of a triage scale is not to be 100% predictive of
outcome, but to ensure that more urgent cases are seen faster. This really
only becomes a problem when the scale starts to be used as a performance
measure, with waiting time targets. In Australia, the target of 30 mins
for ATS Category 3 patients is becoming very difficult to meet. It is yet
to be shown whether the 30 min target is clinically valid, with methods of
linking to clinical outcomes for far being elusive.
Neither the Van Veen paper nor the accompanying editorial appeared to
be aware of the Australasian work that produced the first published five-
point triage scale in 1993 (Australasian College for Emergency Medicine).
Following a study of over 11,000 occasions of triage by Whitby et al, a
groupd of clinical descriptors was linked to the scale, and it was updated
and published as the Australasian Triage Scale (ATS) in 2000. The
descriptors can be found at
http://www.acem.org.au/media/policies_and_guidelines/G24_Implementation_...,
with an accompanying paper at
http://www.acem.org.au/media/policies_and_guidelines/G24_Implementation_....
This work formed the basis of subsequent five-point scales, including
both Manchester and CTAS. The clinical descriptors were found to be
significantly correlated with the categories. There are specific
descriptors for paediatric presentations. Although it has proven
impossible to show that triage categorisation affects clinical outcome
(because of the difficulty in controlling - or even knowing - the time of
onset), the categories have been shown to correlate with admission rates
to hospital.
It is puzzling to see a study that attempts to validate the
Manchester scale against the standard of a local, less-validated scale,
and puzzling that the standard was not precisely described in the
published study. Can the authors give us more information about their
standard and how it was derived? How has the local standard been
validated?
The main purpose of a triage scale is not to be 100% predictive of
outcome, but to ensure that more urgent cases are seen faster. This really
only becomes a problem when the scale starts to be used as a performance
measure, with waiting time targets. In Australia, the target of 30 mins
for ATS Category 3 patients is becoming very difficult to meet. It is yet
to be shown whether the 30 min target is clinically valid, with methods of
linking to clinical outcomes for far being elusive.
Competing interests:
None declared
Competing interests: No competing interests