Impact of Point-of-care Lactate Testing as Triage Supplement on Patient Management Using Manchester Triage System

Although the Manchester Triage System (MTS) is widely used and validated internationally, it has some limitations. Its accuracy is moderate, especially for children and the elderly. Rising patient numbers and overcrowded emergency departments increase wait times, sometimes beyond safe limits. In Slovenia, MTS has been in use for 14 years without major updates, despite a significant rise in emergency visits. The yellow triage category (60-minute wait time) includes a very diverse group of patients, some of whom might require faster care. Older patients, in particular, often show atypical symptoms and may be under-triaged. Including rapid bedside lab tests, like blood lactate levels, could improve risk assessment and triage accuracy. Elevated lactate is linked with higher mortality and can help identify critically ill patients more effectively. The proposed study is a prospective, randomized trial involving two groups of patients in the yellow triage category, all of whom will have their capillary blood lactate levels measured. Patients with normal lactate levels will be excluded. Only patients with elevated lactate will be compared. The test group will be re-triaged to the orange category and treated more urgently. The control group, despite also having high lactate levels, will remain in the yellow category, and their elevated lactate values will not be shared with the treating physician. Randomization will be based on the patient's birth date (even days = test group, odd days = control group). Only the nurse will know the result, maintaining physician blinding to avoid the Hawthorne effect-changes in behavior due to awareness of being studied. Standard lab tests will be performed later during treatment as deemed necessary by the attending doctor.

Study Overview

• Status: Recruiting
• Conditions: Emergency Medicine; Triage; Emergency Department Triage; Emergency Department Overcrowding
• Intervention / Treatment: Diagnostic test: re-triage

• Study Type: Interventional
• Enrollment (Estimated): 200
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Jerica Zaloznik Djordjevic, MD; Phone Number: 00386 31 696 858; Email: jerica.zalo@gmail.com

Study Locations

• Slovenia
  • Maribor, Slovenia
    • Recruiting
    • University Medical Center Maribor
    • Contact: Jerica Zaloznik Djordjevic, MD; Phone Number: 00386 31 696 858; Email: jerica.zalo@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• signed consent, yellow MTS triage category

Exclusion Criteria:

• pregnant women, trauma patients, epileptic seizures, adrenergic therapy in prehospital unit

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Screening
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control group - No-retriage
Experimental: Test group - Retriage to orange MTS group	Diagnostic test: re-triage; Patients in the test group will be re-triaged into the orange MTS category.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Vasoactive drug use	30-day

Secondary Outcome Measures

Outcome Measure	Time Frame
In-hospital mortality	30-day
ICU admission	30-day

Collaborators and Investigators

• Sponsor: University Medical Centre Maribor

Study record dates

Study Major Dates

• Study Start (Actual): July 10, 2025
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): December 31, 2026

Study Registration Dates

• First Submitted: July 16, 2025
• First Submitted That Met QC Criteria: August 7, 2025
• First Posted (Estimated): August 14, 2025

Study Record Updates

• Last Update Posted (Estimated): August 14, 2025
• Last Update Submitted That Met QC Criteria: August 7, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: IRP-2024/01-13

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared with other researchers. The decision not to share IPD is based on privacy concerns, data protection regulations, and institutional policy.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No