***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To vali date use of the Manchester triage system in paediatric emergency care . Design Prospect i ve observational study . Setting Emergency departments of a university hospital and a teaching hospital in the Netherl and s , 2006 - 7 . Participants 17 600 children ( aged < 16 ) visiting an emergency department over 13 months ( university hospital ) and seven months ( teaching hospital ) . Intervention Nurses triaged 16 735/17 600 patients ( 95 % ) using a computerised Manchester triage system  , which calculated urgency levels from the selection of discriminators embedded in flowcharts for presenting problems . Nurses over-ruled the urgency level in 1714 ( 10 % ) children , who were excluded from analysis . Complete data for the reference st and ard were unavailable in 1467 ( 9 % ) children leaving 13 554 patients for analysis . Main outcome measures Urgency according to the Manchester triage system  compared with a predefined and independently assessed reference st and ard for five urgency levels . This reference st and ard was based on a combination of vital signs at presentation , potentially life threatening conditions , diagnostic re sources , therapeutic interventions , and follow-up . Sensitivity , specificity , and likelihood ratios for high urgency ( immediate and very urgent ) and 95 % confidence intervals for subgroups based on age , use of flowcharts , and discriminators . Results The Manchester urgency level agreed with the reference st and ard in 4582 of 13 554 ( 34 % ) children ; 7311 ( 54 % ) were over-triaged and 1661 ( 12 % ) under-triaged . The likelihood ratio was 3.0 ( 95 % confidence interval 2.8 to 3.2 ) for high urgency and 0.5 ( 0.4 to 0.5 ) for low urgency ; though the likelihood ratios were lower for those presenting with a medical problem ( 2.3 ( 2.2 to 2.5 ) v 12.0 ( 7.8 to 18.0 ) for trauma ) and in younger children ( 2.4 ( 1.9 to 2.9 ) at 0 - 3 months v 5.4 ( 4.5 to 6.5 ) at 8 - 16 years ) . Conclusions The Manchester triage system has moderate validity in paediatric emergency care . It errs on the safe side , with much more over-triage than under-triage compared with an independent reference st and ard for urgency . Triage of patients with a medical problem or in younger children is particularly difficult OBJECTIVES Initial studies have shown improved reliability and validity of a new triage tool , the Emergency Severity Index ( ESI ) , over conventional three-level scales at two university medical centers . After pilot implementation and validation , the ESI was revised to include pediatric and up date d vital signs criteria . The goal of this study was to assess ESI version ( v. ) 2 reliability and validity at seven emergency departments ( EDs ) in three states . METHODS In part 1 , interrater reliability was assessed using weighted kappa analysis of written training cases and postimplementation by a r and om sampling of actual patient triages . In part 2 , validity was analyzed using a prospect i ve cohort with stratified r and om sampling at each site . The ESI was compared with outcomes including re source consumption , inpatient admission , ED length of stay , and 60-day all-cause mortality . RESULTS Weighted kappa analysis of interrater reliability ranged from 0.70 to 0.80 for the written scenarios ( n = 3289 ) and 0.69 to 0.87 for patient triages ( n = 386 ) . Outcomes for the validity cohort ( n = 1042 ) included hospitalization rates by ESI triage level : level 1 , 83 % ; 2 , 67 % ; 3 , 42 % ; 4 , 8 % ; level 5 , 4 % . Sixty-day all-cause mortality by triage level was as follows : level 1 , 25 % ; 2 , 4 % ; 3 , 2 % ; 4 , 1 % ; and 5 , 0 % . CONCLUSIONS ESI v. 2 triage produced reliable , valid stratification of patients across seven sites . ESI triage should be evaluated as an ED casemix identification system for uniform data collection in the United States and compared with other major ED triage methods Introduction The FRench Emergency Nurses Classification in Hospital scale ( FRENCH ) is the first French triage tool for patients visiting an emergency department . The FRENCH scale modified in 2006 , based on about 100 determinants ( complaints , signs , and vital parameters ) , allows the triage of adult patients according to five increasing levels of complexity/severity . We evaluated FRENCH version 2 ( v.2 ) in our emergency department . Methods Reliability was evaluated on 300 prospect ively selected patient records ( 50 % of patients admitted ) . Three nurse pairs , blinded with respect to the original triage , retrospectively and independently triaged 100 patients .  Interrater reliability within the pairs was measured with a weighted κ . Validity was evaluated on all triaged patients ( N=941 ) over 14 days by study ing the relationships between the original triage category assigned by the triage nurse and re source consumption and the admission rate . Results Interrater reliability was good [ K=0.77 ( 95 % confidence interval : 0.71–0.82 ) ] . Distribution of the 941 patients included in the validation study ( 18 % of whom were admitted ) was as follows [ n ( % ) ] : 2 ( 0.2 ) , 33 ( 4 ) , 258 ( 27 ) , 451 ( 48 ) , and 197 ( 21 ) for a triage from 1 to 5 , respectively . Re source consumption correlated well with case severity as assessed by the triage category ( R=−0.643 , P<0.0001 ) . Finally , the area under the receiver operating characteristic curve for prediction of admission as a function of triage was 0.858 ( 95 % confidence interval : 0.831–0.885 ) . Conclusion FRENCH v.2 is a reliable and vali date d triage tool to predict the complexity/severity of a patient in our emergency department Background The Manchester Triage System ( MTS ) determines an inappropriately low level of urgency ( undertriage ) to a minority of children . The aim of the study was to assess the clinical severity of  undertriaged patients in the MTS and to define the determinants of undertriage . Methods Patients who had attended the emergency department ( ED ) were triaged according to the MTS . Undertriage was defined as a ‘ low urgent ’ classification ( levels 3 , 4 and 5 ) under the MTS ; as a ‘ high urgent ’ classification ( levels 1 and 2 ) under an independent reference st and ard based on abnormal vital signs ( level 1 ) , potentially life-threatening conditions ( level 2 ) , and a combination of re source use , hospitalisation , and follow-up for the three lowest urgency levels . In an expert meeting , three experienced paediatricians used a st and ardised format to determine the clinical severity . The clinical severity had been expressed by possible consequences of treatment delay caused by undertriage , such as the use of more interventions and diagnostics , longer hospitalisation , complications , morbidity , and mortality . In a prospect i ve observational study we used logistic regression analysis to assess predictors for undertriage . Results In total , 0.9 % ( 119/13,408 ) of the patients were undertriaged . In 53 % ( 63/119 ) of these patients , experts considered undertriage as clinical ly severe . In 89 % ( 56/63 ) of these patients the high reference urgency was determined on the basis of abnormal vital signs . The prospect i ve observational study showed undertriage was more likely in infants ( especially those younger than three months ) , and in children assigned to the MTS ‘ unwell child ’ flowchart ( adjusted OR<3 months 4.2 , 95 % CI 2.3 to 7.7 and adjusted ORunwell child 11.1 , 95 % CI 5.5 to 22.3 ) . Conclusion Undertriage is infrequent , but can have serious clinical consequences . To reduce significant undertriage , the authors recommend a systematic assessment of vital signs in all children OBJECTIVES The objective was to compare the validity of an existing informally structured triage system with the Emergency Severity Index ( ESI ) and the Manchester Triage System ( MTS ) . METHODS A total of 900 patients were prospect ively triaged by six trained triage nurses using the three systems . Triage ratings of 421 ( 48 % ) patients treated only by emergency department ( ED ) physicians were compared with a reference st and ard determined by an expert panel . The percentage of undertriage , the sensitivity , and the specificity for each urgency level were calculated . The relationship between urgency level , re source use , hospitalization , and length of stay ( LOS ) in the 900 triaged patients was determined . RESULTS The percentage of undertriage using the ESI ( 86 of 421 ; 20 % ) was significantly higher than in the MTS ( 48 of 421 ; 11 % ) . When combining urgency levels 4 and 5 , the percentage of undertriage was 8 % for the informally structured system ( ISS ) , 14 % for the ESI , and 11 % for the MTS . In all three systems , sensitivity for all urgency levels was low , but specificity for levels 1 and 2 was high ( > 92 % ) . Sensitivity and specificity were significantly different between ESI and MTS only in urgency level 4 . In all 900 patients triaged , urgency levels across all systems were associated with significantly increased re source use , hospitalization rate , and LOS . CONCLUSIONS All three triage systems appear to be equally valid . Although the ESI showed the highest percentage of undertriage and the ISS the lowest , it seems preferable to use a verifiable , formally structured triage system Objective : To assess the reliability and validity of the Manchester Triage System ( MTS ) in a general emergency department patient population . Methods : A prospect i ve evaluation study was conducted in two general hospitals in the Netherl and s. Emergency department nurses from both hospitals triaged 50 patient vignettes into one of five triage categories in the MTS .  Triage ratings were compared with the ratings of two Dutch MTS experts to measure inter-rater reliability . Nineteen days after triaging the patient vignettes , triage nurses were asked to rate the same vignettes again to measure test-retest reliability . Reliability in relation to the work experience of emergency department nurses was also studied . Validity was assessed by calculating percentages for overtriage , undertriage , sensitivity and specificity . Results : Inter-rater reliability was “ substantial ” ( weighted kappa 0.62 ( 95 % CI 0.60 to 0.65 ) ) and test-retest reliability was high ( intraclass correlation coefficient 0.75 ( 95 % CI 0.72 to 0.77 ) ) . No significant association was found between the experience of emergency department nurses and the reliability score ( kappa ) . Undertriage occurred more frequently than overtriage , especially in elderly patients ( 25.3 % vs 7.6 % ) . Sensitivity for urgent patients in the MTS was 53.2 % and specificity was 95.1 % . The patient vignettes representing children aged < 16 years revealed a higher sensitivity ( 83.3 % ) . Conclusions : Inter-rater reliability is “ moderate ” to “ substantial ” and test-retest reliability is high . The reliability of the MTS is not influenced by nurses ’ work experience . Undertriage mainly occurs in the MTS categories orange and yellow . The MTS is more sensitive for children who need immediate or urgent care than for other patients in the emergency department INTRODUCTION Each of the two most commonly used five-level triage tools in North America , the Emergency Severity Index and the Canadian Triage and Acuity Scale have been used as a measure of emergency department re source utilization in addition to acuity . In both cases , it is believed that patients triaged as having a higher level of acuity require a greater number of emergency department re sources . We compared the ability of each tool to predict the emergency department re sources for each emergency department visit and associated hospital admission and in-hospital mortality rates . METHODS This is an observational , cohort study of a population -based r and om sample of patients triaged at two emergency departments over a 4-month period . Correlational analyses were performed to examine the relationship between the triage assessment and : ( i ) re source utilization , ( ii ) hospital admission , and ( iii ) in-hospital mortality . RESULTS From 486 patients , analyses revealed the greatest correlation was between Emergency Severity Index and diagnostic re sources [ -0.54 ( 95 % confidence intervals : -0.58 , -0.50 ) ] and the poorest correlation was between Canadian Triage and Acuity Scale and mortality [ -0.16 ( 95 % confidence intervals : -0.20 , -0.12 ) ] . No statistically significant differences ( P<0.005 ) were observed between each tool 's ability to predict any of the outcomes measured . CONCLUSION No statistically significant difference was observed in the ability of Emergency Severity Index v. 3 and Canadian Triage and Acuity Scale to predict emergency department re source utilization or immediate patient outcomes . This ability is , at best , only moderate indicating that other , more accurate tools than measures of triage acuity are required for this purpose OBJECTIVES Triage is the initial clinical sorting process in hospital emergency departments ( EDs ) . Because of poor reproducibility and validity of three-level triage , the authors developed and vali date d a new five-level triage instrument , the Emergency Severity Index ( ESI ) . The study objectives were : 1 ) to vali 
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Its safety was low because of the high rate of undertriage and the low sensitivity in predicting higher urgency levels .
The high rate of overtriage could cause unnecessarily high use of re sources in the emergency department .