The Reliability of the Manchester Triage System (MTS): a Meta-analysis

Objective: Although the Manchester Triage System (MTS) was first developed two decades ago, the reliability of the MTS has not been questioned through comparison with a moderating variable; therefore, the aim of this study is to determine the extent of the reliability of MTS using a meta-analytic review.

Method: Electronic databases were searched up to 1 March 2014. Studies were only included if they had reported sample sizes, reliability coefficients, and adequate description of the reliability assessment. The Guidelines for Reporting Reliability and Agreement Studies was used. Two reviewers independently examined abstracts and extracted data. The effect size was obtained by the z-transformation of reliability coefficients. Data were pooled with random-effects models, and meta-regression was performed based on the method-of-moments estimator.

Results: Seven studies were included. The pooled coefficient for the MTS was substantial at 0.751 (CI 95%: 0.677 to 0.810); the incidence of mistriage is greater than 50%. Agreement is higher for the latest version of MTS (for adults) among nurse-experts and in countries in closer proximity to the country of MTS origin (the UK, in Manchester) than for the oldest (pediatric) version, nurse-nurse raters, and countries at a greater distance from the UK.

Conclusion: The MTS showed an acceptable level of overall reliability in the emergency department, but more development is required to attain almost perfect agreement.