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The following is a summary of “Comparing the National Early Warning Score and the Manchester Triage System in Emergency Department Triage: A Multi-Outcome Performance Evaluation,” published in the April 2025 issue of Diagnostics by Zaboli et al. 

The National Early Warning Score (NEWS) was recently proposed as a potential alternative to traditional emergency department (ED) triage systems for prioritizing patients based on clinical severity, but its significance across various clinical outcomes had not been fully established.  

Researchers conducted a retrospective study to compare the predictive performance of the NEWS and the Manchester Triage System (MTS) across multiple clinical outcomes.  

They compared the performance of the NEWS and the MTS at Merano Hospital, Italy, between 1 June 2022 and 30 June 2023. All adult ED individuals (≥18 years) were included, excluding those on fast-track pathways, non-residents individuals. Primary outcomes were 30-day mortality, hospitalization, and ICU admission. A random 5% subgroup was analyzed for secondary outcomes, including life-saving interventions (LSIs), physician-defined clinical priority, and severity. Predictive performance was evaluated using Receiver Operating Characteristic (ROC) curves, the area under the ROC curve (AUROC), and Decision Curve Analysis (DCA).  

The results showed that among 27,238 individuals, the NEWS demonstrated stronger predictive accuracy for 30-day mortality than the MTS (AUROC 0.745 vs 0.701, P < 0.001). In contrast, the MTS showed higher predictive value for hospitalization (AUROC 0.733 vs 0.609, P < 0.001), ICU admission (AUROC 0.862 vs 0.672, P < 0.001), and all assessed secondary outcomes. The DCA also confirmed the MTS performed better across ED thresholds ranging from 20% to 40% (20–40%).  

Investigators concluded that while the NEWS effectively predicted mortality, the MTS remained the better system for prioritizing high-risk patients based on clinical severity. 

Source: mdpi.com/2075-4418/15/9/1055