Question 1

Which triage system is better — MTS or ESI?

Accepted Answer

Both have good reliability and validity. MTS may better predict hospitalisation and ICU admission; ESI better predicts ED resource consumption and length of stay. The choice is usually institutional. MTS is more prevalent in Europe, ESI in North America. Both require formal training and auditing to maintain reliability.

Question 2

Can MTS be used for telephone triage?

Accepted Answer

Yes — versions of MTS have been adapted for telephone triage and telehealth. However, the absence of visual cues and vital sign measurement limits diagnostic accuracy. Telephone triage using MTS should use a modified discriminator set that emphasises history-based discriminators.

Question 3

How is MTS reliability maintained?

Accepted Answer

Regular audit of triage decisions, case-based discussion, and refresher training are essential. Target is >90% agreement within one category. Many institutions use the eMTS (electronic MTS) platform with decision-support prompts. Annual MTS recertification is recommended for all triage clinicians.

Question 4

Does MTS under-triage or over-triage specific populations?

Accepted Answer

MTS tends to over-triage older adults (higher acuity assigned for the same clinical presentation) which may lead to unnecessary resource allocation. It may under-triage patients with mental health presentations or non-specific symptoms (e.g., malaise, fatigue). Ongoing validation in specific subpopulations is an active area of research.