Valor de predição do protocolo Manchester em um hospital do Vale do Jequitinhonha

Abstract

The Manchester Triage System (MTS) is used in the classification of patients in the emergency rooms of Minas Gerais, Brazil. The MTS defines the clinical priority and recommended time of patient care from the entrance drive to the doctor in attendance. The aim of this study was to analyze the predictive value of the MTS to the clinical evolution of the patients of a hospital in Jequitinhonha Vale in Minas Gerais. This is a prospective observational study of patients admitted to the Emergency Department (ED) of the Santa Casa of Diamantina - MG that passed through the rating process. Patients transferred to another hospital, those who died or were discharged before 24 hours of data collection and those under the age of 18 years old were excluded. Data collection was conducted through semi-structured questionnaire. In order to measure the severity of patients (primary outcome) the Therapeutic Intervention Scoring System (TISS-28) was used. Secondary outcomes were evaluated: death, discharge/transfer and length of hospital stay. Descriptive statistics and inferential frequency analysis were used to characterize patients. The association between qualitative variables was performed by chi- square test. The relationship between the average score received in TISS-28 and time spent in each classification group was tested by Kruskal-Wallis test. Significance level of p 0.05 was adopted. Subsequently the Mann-Whitney test was applied. The strength of association between variables was estimated by odds ratio (OR), confidence interval of 95%. In order to control confounding variables, a logistic regression was performed. From the 577 patients classified 335 (58.1%) were male, mean age 58.7 years. Patients were classified in colors red (3.6%), orange (27.4%), yellow (46.3%), white (10.7%), blue (0.2%), white (11.8%). In relation to referrals, the PS was used by the population as the main gateway to the health service (38.3%). The main complaints were: malaise in adults (22.5%), dyspnea in adults (14.0%), abdominal pain in adults (10.0%), behavioral changes (5.9%). The mean TISS-28 score in patients classified in red was 27.9 points, in orange 17.1, in color yellow 14.7 points, 13.5 points in green and 12,2 points in white. Patients classified in red had 10.7 times more chances to have a score above 14 in TISS-28 than in the other colors. As to the final outcome, 83.5% was discharged. Proportionally was found more deaths among patients in the group of most severe classification: 42.8% red, 17.0% orange and 8.9% yellow. It was found that 9.6% of green patients died during follow up, and 7.3% of whites also had the same outcome. Patients classified as red were 5.9 times more chances of progression to death compared to those classified in other colors. Regarding the time of hospitalization the average length of hospital stay decreased in the same order of complexity of patients: red (10.6 days), orange (8.5 days), yellow (6.9 days), green (6.9 days), white (4.9 days). Patients high priority treatments were 1.5 times more chance to be hospitalized for more than 5 days of low clinical priority. We conclude that the MTS has proved to be a good predictor of clinical severity, for high/transfer and death secondary outcome and also for the hospital stay.