Evaluation of the agreement and clinical effectiveness of a mobile self-triage application with professional triage in the emergency department

Aim: The aim of this study is to evaluate the concordance and clinical effectiveness of the mobile self-triage application we developed for use in the emergency department, in comparison with professional triage performed according to the Manchester Triage System (MTS). Materials and Methods: This prospective, observational, single-center study was conducted in the Emergency Department of Balıkesir University Practice and Research Hospital. Following ethics committee approval, patients who presented to the emergency department between 01.07.2025 and 15.10.2025, were 18 years of age or older, had stable vital signs, were in the yellow/green triage category, and provided informed consent were included in the study. Patients performed self-triage on a tablet screen using the Mobile Emergency Department Self-Triage Program we developed; afterwards, trained healthcare personnel determined the professional triage category according to the MTS flowcharts. The concordance between these two results was compared across different parameters. Results: Of the 3246 patients who used the application, 970 patients who selected "Other" as their complaint were excluded, and 2276 patients were analyzed. The mean age was 44.4±18.2 years, and 55% of the patients were female. According to the self-triage results, 43.3% of the patients were category 2 and 40.3% were category 3; whereas in professional MTS triage, 43.5% of the patients were classified as category 4 and 40.8% as category 3. When self-triage and professional triage were compared, 42.6% concordant triage, 51.1% over-triage, and 6.4% under-triage were identified. It was observed that over-triage rates increased as pain severity increased, and that concordant triage rates were higher in patients presenting with diarrhea and vomiting. The group that performed over-triage consisted of younger patients. Conclusion: The mobile self-triage application demonstrates an acceptable profile in terms of patient safety, with low levels of under-triage and moderate levels of concordance. However, due to the high rate of over-triage, it should be considered as an auxiliary tool for emergency department triage rather than an independent system replacing professional triage. Reorganizing the algorithms through multicenter studies and improving them on a symptom-based basis may enhance its clinical effectiveness. Keywords: Emergency department, Emergency department overcrowding, Mobile-triage, Self-triage, Triage systems