6881 Presentations to the paediatric emergency department (PED): how urgent is urgent?

Objectives In the UK, the Manchester Triage System (MTS) is used on attendance to the emergency department (ED). MTS categorises patients presenting to the ED as immediate (score 1), very urgent (score 2), urgent (score 3), standard (score 4), and non-urgent (score 5). Despite reasonable sensitivity and specificity of triage scores reported, studies have shown that over-cautious triaging can occur.1 This risks classifying patients as more urgent on triage than their subsequent course supports. Triage scores of standard/semi-urgent and non-urgent are used to denote low acuity. Over-triaging raises questions regarding the true incidence of low acuity presentations. Low acuity presentations, which could safely be managed in a community setting other than PED, place a significant burden on limited resources. We aimed to describe the characteristics of those patients assigned MTS scores of 3 and above in our district general hospital (DGH) PED. Methods This study included all patients aged 0–17 who presented to a DGH PED between June 1st, 2022, and May 31st, 2023. To enable operational feasibility, an MTS score less than 3, and/or admission, transfer, or death, were used as proxies of high acuity; these patients were excluded. All remaining patients were considered as potentially of low acuity and were included. Using retrospective analysis of anonymised data from electronic health records (EHRs), the characteristics of these patients were explored, including age, chief complaint, diagnosis on discharge, MTS score assigned, paediatric early warning score on triage (PEWS), discharge medications dispensed, and discharge destination. Results A total of 17214 patients met our criteria. 53% were children under 5 years old. 72% had an MTS of 4, and 25% a score of 3. With respect to PEWS, 60% of patients had a score of 0. Only 1.4% of patients had a PEWS score greater than or equal to 2. Most common chief complaints were fever, cough, and abdominal pain. Most common ED diagnoses were upper respiratory tract infection, 'no abnormality detected', and tonsillitis. 1% of patients were discharged home with salbutamol, and 13% with oral antibiotics. 25% of patients included were classified as MTS 3, we further explored this group, removing the exclusion criteria of admission, death and transfer to include all MTS patients. Of 5046 patients, 0.3% of patients required transfer to other hospitals and only 13% required admission. 86% of patients were discharged home. Conclusion Significant proportion of patients with MTS of 3 were discharged home with no complications. This finding raises further questions of about MTS 3 patients; can they be classified as low acuity and are their characteristics similar or different to those of MTS 4 or 5. Ongoing evaluation of MTS 3 patients is necessary and as this will not only dictate how and where we care for these patients, but also strategic tilization of healthcare resources. Reference van Veen M, Steyerberg EW, Ruige M, van Meurs AH, Roukema J, van der Lei J, Moll HA. Manchester triage system in paediatric emergency care: prospective observational study. BMJ. 2008 Sep 22;337:a1501. doi: 10.1136/bmj.a1501. Erratum in: BMJ. 2008;337:a1849. PMID: 18809587; PMCID: PMC2548283.