{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T18:37:44Z","timestamp":1775673464911,"version":"3.50.1"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Over the past 25 years, numerous studies have evaluated triage system performance, but longitudinal data are limited. This study is the first to assess the Manchester Triage System (MTS) over a decade to determine the accuracy of initial patient assessments and system stability under external influences such as staff turnover, health policy changes, demographic shifts, and the COVID-19 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a large-scale, monocentric, retrospective observational study at a tertiary care hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 2014 and 2023 a total of 355,135 emergency patients were included. Average age increased from 48.1 to 52.1 years. The distribution of the five MTS urgency levels remained stable. Prediction of hospital admission (AUC 0.719\u20130.756) and ICU admission (AUC 0.831\u20130.862) was consistent throughout the period. Twelve-hour survival probabilities were above 0.99 for \u201cblue\u201d to \u201corange\u201d patients and above 0.89 for \u201cred\u201d patients. Short-term mortality prediction (AUC) ranged from 0.845 to 0.894. Thirty-day survival remained &gt;0.8 for \u201cblue\u201d to \u201corange\u201d stages, while the \u201cred\u201d stage declined from 0.63 (2014) to 0.44 (2023). The AUC for 30-day mortality increased from 0.672 to 0.750 over the decade.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Construct validity assessment demonstrates that the MTS reliably assigns appropriate urgency levels to incoming emergency patients. Longitudinal evaluation shows that its accuracy remained stable over ten years despite high staff turnover, health policy and demographic changes, and the COVID-19 pandemic. These findings confirm the robustness and reliability of the MTS in a high-volume tertiary care setting and support its continued use for emergency patient prioritization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0344598","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T17:21:57Z","timestamp":1775668917000},"page":"e0344598","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["A decade of triage with the Manchester Triage System-The MTS big data study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6976-1735","authenticated-orcid":true,"given":"Ingo","family":"Gr\u00e4ff","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moritz","family":"Berger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Schmid","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monika","family":"Kogej","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"issue":"8","key":"pone.0344598.ref001","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1007\/s10049-021-00946-1","article-title":"Pr\u00e4valenz und Ursachen von Fehltriagierung am Beispiel einer universit\u00e4ren Notaufnahme","volume":"26","author":"J B\u00fcrger","year":"2021","journal-title":"Notfall Rettungsmed"},{"issue":"4","key":"pone.0344598.ref002","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.jclinepi.2009.07.009","article-title":"Challenges in the validation of triage systems at emergency departments","volume":"63","author":"HA Moll","year":"2010","journal-title":"J Clin Epidemiol"},{"issue":"5","key":"pone.0344598.ref003","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-026471","article-title":"Performance of triage systems in emergency care: a systematic review and meta-analysis","volume":"9","author":"JM Zachariasse","year":"2019","journal-title":"BMJ Open"},{"issue":"3","key":"pone.0344598.ref004","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1136\/emj.16.3.179","article-title":"Does the Manchester triage system detect the critically ill?","volume":"16","author":"MW Cooke","year":"1999","journal-title":"J Accid Emerg Med"},{"issue":"2","key":"pone.0344598.ref005","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0088995","article-title":"The German Version of the Manchester Triage System and its quality criteria--first assessment of validity and reliability","volume":"9","author":"I Gr\u00e4ff","year":"2014","journal-title":"PLoS One"},{"key":"pone.0344598.ref006","article-title":"Ersteinsch\u00e4tzung in der klinischen Akut- und Notfallmedizin \u2013 Hintergrundwissen f\u00fcr die Praxis","author":"I Gr\u00e4ff","year":"2024","journal-title":"Notfall Rettungsmed"},{"key":"pone.0344598.ref007","volume-title":"Ersteinsch\u00e4tzung in der Notaufnahme","author":"K Mackway-Jones","year":"2020","edition":"5"},{"key":"pone.0344598.ref008","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1056\/NEJMoa1513223","article-title":"Life expectancy after myocardial infarction, according to hospital performance","volume":"375","author":"EM Bucholz","year":"2016","journal-title":"N Engl J Med"},{"issue":"5","key":"pone.0344598.ref009","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.annemergmed.2025.02.003","article-title":"Outcomes of Older Adults With Delirium Discharged From the Emergency Department","volume":"86","author":"AS Howick","year":"2025","journal-title":"Ann Emerg Med"},{"issue":"03","key":"pone.0344598.ref010","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1055\/s-0043-119448","article-title":"Ersteinsch\u00e4tzung in der Zentralen Notaufnahme","volume":"13","author":"I Gr\u00e4ff","year":"2018","journal-title":"Notf.med up2date"},{"key":"pone.0344598.ref011","author":"N \u00c4rztekammer"},{"key":"pone.0344598.ref012","unstructured":"Welt\u00e4rztebund. 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