{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:15:55Z","timestamp":1788243355149,"version":"build-2803163510"},"reference-count":34,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:00:00Z","timestamp":1787961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Digital self-triage tools may support patient-flow management in crowded emergency departments (EDs), but their agreement with established professional triage systems requires prospective validation. We evaluated the agreement and classification performance of a locally developed mobile self-triage application, structured according to Manchester Triage System (MTS)-related urgency logic, compared with professional MTS assessment in adult ED patients. Methods: This prospective, observational, single-center agreement study included 2274 consecutive, hemodynamically stable adult walk-in patients who used a tablet-based application covering 11 predefined presenting complaints and subsequently underwent a single, blinded professional MTS assessment, which served as the prespecified comparator. Of 3244 initial registrations, 970 (29.9%) were excluded because their complaints were not covered by the predefined pathways. MTS Categories 2\u20133 were classified as urgent. Results: Exact agreement occurred in 968 patients (42.6%); 1161 patients (51.1%) were overtriaged and 145 (6.3%) were undertriaged. The application showed 93.9% sensitivity, 28.7% specificity, 61.1% positive predictive value, and 79.8% negative predictive value for identifying professional MTS-defined urgent cases. Agreement was slight by unweighted kappa (\u03ba = 0.198), fair by quadratically weighted kappa (\u03baw = 0.278), and the prevalence- and bias-adjusted kappa for binary urgent\/non-urgent classification was 0.28. Overtriage exceeded 70% for headache and low back pain, and these complaints were the strongest independent predictors of overtriage; higher self-reported pain intensity was strongly associated with overtriage. Conclusions: The application demonstrated a conservative classification profile with high sensitivity and a low undertriage rate but frequent overtriage that would inflate the apparent urgent caseload if the tool were used unsupervised; it should be considered an adjunct to, rather than a replacement for, professional triage. Findings apply to stable adult walk-in patients whose complaints matched the predefined categories and may not generalize to the broader ED population.<\/jats:p>","DOI":"10.3390\/jcm15176702","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:45:13Z","timestamp":1788241513000},"page":"6702","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Agreement and Classification Performance of a Mobile Self-Triage Application Based on the Manchester Triage System in Hemodynamically Stable Adult Walk-In Emergency Department Patients: A Prospective Observational Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4291-2660","authenticated-orcid":false,"given":"Ahmet Bu\u011fra","family":"\u00d6nler","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Balikesir State Hospital, 10020 Balikesir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0654-8061","authenticated-orcid":false,"given":"Suha","family":"Serin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Balikesir University, 10145 Balikesir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4164-393X","authenticated-orcid":false,"given":"Bahadir","family":"Caglar","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, Balikesir University, 10145 Balikesir, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,29]]},"reference":[{"key":"ref_1","first-page":"496","article-title":"Y\u0131ll\u0131k 300 milyon hasta muayenesi: T\u00fcrkiye\u2019de 2. ve 3. basamak kamu sa\u011fl\u0131k tesisleri acil servis ve poliklinik hizmetlerinin de\u011ferlendirilmesi","volume":"12","year":"2022","journal-title":"Sak. Med. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1097\/EC9.0000000000000078","article-title":"Emergency department overcrowding: Causes and solutions","volume":"3","author":"Butun","year":"2023","journal-title":"Emerg. Crit. Care Med."},{"key":"ref_3","unstructured":"National Center for Health Statistics (2023). National Hospital Ambulatory Medical Care Survey: 2022 Emergency Department Summary Tables."},{"key":"ref_4","unstructured":"Republic of T\u00fcrkiye Ministry of Health, General Directorate of Health Information Systems (2025). Health Statistics Yearbook 2023."},{"key":"ref_5","unstructured":"International Federation for Emergency Medicine (2025, October 25). Global Campaign Against ED Over-Crowding. Available online: https:\/\/www.ifem.cc\/global_campaign_against_ed_over_crowding."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1007\/s11739-023-03239-2","article-title":"Emergency department crowding: An overview of reviews describing measures, causes, and harms","volume":"18","author":"Pearce","year":"2023","journal-title":"Intern. Emerg. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.aucc.2019.09.002","article-title":"Factors contributing to high turnover rates of emergency nurses","volume":"33","author":"McDermid","year":"2020","journal-title":"Aust. Crit. Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1136\/jech.50.4.456","article-title":"Non-urgent care in the hospital medical emergency department in France: How much and which health needs does it reflect?","volume":"50","author":"Lang","year":"1996","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1111\/j.1553-2712.2011.01127.x","article-title":"A population-based study of the association between socioeconomic status and emergency department utilization in Ontario, Canada","volume":"18","author":"Khan","year":"2011","journal-title":"Acad. Emerg. Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Morley, C., Unwin, M., Peterson, G.M., Stankovich, J., and Kinsman, L. (2018). Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0203316"},{"key":"ref_11","first-page":"892","article-title":"Modern triage in the emergency department","volume":"107","author":"Christ","year":"2010","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1067\/men.2002.127184","article-title":"Five-level triage system more effective than three-level in tertiary emergency department","volume":"28","author":"Travers","year":"2002","journal-title":"J. Emerg. Nurs."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Mackway-Jones, K., Marsden, J., and Windle, J. (2014). Emergency Triage: Manchester Triage Group, Wiley-Blackwell. [3rd ed.].","DOI":"10.1002\/9781118299029"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Zachariasse, J.M., Seiger, N., Rood, P.P.M., Alves, C.F., Freitas, P., Smit, F.J., Roukema, G.R., and Moll, H.A. (2017). Validity of the Manchester Triage System in emergency care: A prospective observational study. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0170811"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.ienj.2016.02.003","article-title":"Emergency department crowding affects triage processes","volume":"29","author":"Meester","year":"2016","journal-title":"Int. Emerg. Nurs."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1038\/s41746-023-00758-2","article-title":"The use of kiosks to improve triage efficiency in the emergency department","volume":"6","author":"Joseph","year":"2023","journal-title":"NPJ Digit. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/j.jemermed.2019.11.019","article-title":"Self-check-in kiosks utilization and their association with wait times in emergency departments in the United States","volume":"58","author":"Mahmood","year":"2020","journal-title":"J. Emerg. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1038\/s41746-022-00667-w","article-title":"The diagnostic and triage accuracy of digital and online symptom checker tools: A systematic review","volume":"5","author":"Wallace","year":"2022","journal-title":"NPJ Digit. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"h3480","DOI":"10.1136\/bmj.h3480","article-title":"Evaluation of symptom checkers for self diagnosis and triage: Audit study","volume":"351","author":"Semigran","year":"2015","journal-title":"BMJ"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Pairon, A., Philips, H., and Verhoeven, V. (2023). A scoping review on the use and usefulness of online symptom checkers and triage systems: How to proceed?. Front. Med., 9.","DOI":"10.3389\/fmed.2022.1040926"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1097\/MEJ.0000000000000863","article-title":"Agreement and validity of electronic patient self-triage (eTriage) with nurse triage in two UK emergency departments: A retrospective study","volume":"29","author":"Dickson","year":"2022","journal-title":"Eur. J. Emerg. Med."},{"key":"ref_22","first-page":"e14002","article-title":"A comparison between computer-assisted self-triage by patients and triage performed by nurses in the emergency department","volume":"13","author":"Trivedi","year":"2021","journal-title":"Cureus"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Gilbert, A., Diep, A.N., Boufraioua, M., P\u00e9tr\u00e9, B., Donneau, A.F., and Ghuysen, A. (2022). Patients\u2019 self-triage for unscheduled urgent care: A preliminary study on the accuracy and factors affecting the performance of a Belgian self-triage platform. BMC Health Serv. Res., 22.","DOI":"10.1186\/s12913-022-08571-5"},{"key":"ref_24","unstructured":"Google (2025, July 02). Android Studio\u2014Android Developers. Available online: https:\/\/developer.android.com\/studio."},{"key":"ref_25","unstructured":"JetBrains (2025, July 02). Kotlin v2.2.21. Available online: https:\/\/kotlinlang.org."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e69528","DOI":"10.2196\/69528","article-title":"Safety and efficacy of digital check-in and triage kiosks in emergency departments: Systematic review","volume":"27","author":"Greenfield","year":"2025","journal-title":"J. Med. Internet Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e32340","DOI":"10.2196\/32340","article-title":"Safety of triage self-assessment using a symptom assessment app for walk-in patients in the emergency care setting: Observational prospective cross-sectional study","volume":"10","author":"Cotte","year":"2022","journal-title":"JMIR Mhealth Uhealth"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1038\/s41746-025-01566-6","article-title":"Accuracy of online symptom assessment applications, large language models, and laypeople for self-triage decisions","volume":"8","author":"Kopka","year":"2025","journal-title":"NPJ Digit. Med."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Trivedi, S.V., Batta, R., Henao-Romero, N., Mondal, P., Wilson, T., and Stempien, J. (2024). A comparison of self-triage tools to nurse driven triage in the emergency department. PLoS ONE, 19.","DOI":"10.1101\/2024.01.04.24300856"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Buleu, F., Popa, D., Williams, C., Tudor, A., Sutoi, D., Trebuian, C., Ioan, C.C., Iancu, A., Cozma, G., and Marin, A.-M. (2024). Code stroke alert: Focus on emergency department time targets and impact on door-to-needle time across day and night shifts. J. Pers. Med., 14.","DOI":"10.3390\/jpm14060596"},{"key":"ref_32","first-page":"645","article-title":"Patients attending emergency departments","volume":"114","author":"Scherer","year":"2017","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e090123","DOI":"10.1136\/bmjopen-2024-090123","article-title":"Association between health anxiety and self-triage decisions: Evidence from a cross-sectional study with Australian emergency department non-urgent patients","volume":"15","author":"Chan","year":"2025","journal-title":"BMJ Open"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/S0196-0644(80)80187-9","article-title":"Emergency physicians\u2019 and patients\u2019 assessments: Urgency of need for medical care","volume":"9","author":"Gifford","year":"1980","journal-title":"Ann. Emerg. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6702\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:52:40Z","timestamp":1788241960000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6702"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,29]]},"references-count":34,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176702"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176702","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,29]]}}}