EWSs and 28-Day Mortality in Geriatric ED Patients (EWSsGer)

Haseki Training and Research Hospital

Status: Completed

Conditions: Mortality; Emergency Department Visits; Geriatric Patients; Frailty; Clinical Deterioration

Treatments: Other: Laboratory Parameters; Other: Early Warning Scores; Other: Severity Scores; Other: Demographic Characteristics; Other: Clinical Frailty Scale; Other: Vital Signs; Other: Comorbidities

Study type: Observational

Funder types: Other

Identifiers

NCT07577349

01/2025

Details and patient eligibility

About

This prospective observational cohort study evaluated the prognostic performance of commonly used early warning scores for predicting 28-day all-cause mortality among geriatric patients presenting to the emergency department with non-traumatic conditions. Patients aged 65 years and older were consecutively screened during the study period. Demographic characteristics, comorbidities, vital signs, level of consciousness, blood gas parameters, complete blood count parameters, frailty status, and early warning scores were recorded at emergency department presentation or within the first hour of admission. The evaluated scoring systems included National Early Warning Score (NEWS/NEWS2), Modified Early Warning Score (MEWS), quick Sequential Organ Failure Assessment (qSOFA), Rapid Emergency Medicine Score (REMS), Cardiac Arrest Risk Triage (CART), and Hamilton Early Warning Score (HEWS) score. The primary outcome was 28-day all-cause mortality. The study also examined whether age, comorbidity burden, frailty, laboratory markers, and hemodynamic parameters were independently associated with 28-day mortality in this population.

Full description

Emergency departments are high-acuity clinical settings in which early recognition of patients at risk of deterioration is essential. Early warning scores are widely used to support risk stratification by converting abnormalities in physiological parameters into structured clinical scores. However, the prognostic performance of these tools may be limited in older adults because of age-related physiological changes, reduced physiological reserve, atypical clinical presentation, polypharmacy, and high comorbidity burden.

This prospective, single-center observational cohort study was conducted in the emergency department of Haseki Training and Research Hospital, Istanbul, Türkiye. Consecutive patients aged 65 years and older who presented with non-traumatic conditions were screened for eligibility. Data were recorded in real time using a standardized case report form. The evaluated early warning scores included the National Early Warning Score, National Early Warning Score 2, Modified Early Warning Score, quick Sequential Organ Failure Assessment, Systemic Inflammatory Response Syndrome criteria, Rapid Emergency Medicine Score, Hamilton Early Warning Score, Triage Early Warning Score, Rapid Acute Physiology Score, and Cardiac Arrest Risk Triage score. The Clinical Frailty Scale was also assessed.

The primary objective was to evaluate the ability of these scores to predict 28-day all-cause mortality. Secondary analyses assessed comparative score performance and explored whether advanced age, comorbidity burden, frailty, laboratory parameters, and hemodynamic variables were independently associated with mortality.

Enrollment: 2,744 patients

Sex: All

Ages: 65+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

Participants will be eligible for inclusion if they meet all of the following criteria:

• Age 65 years or older
• Presentation to the emergency department during the study period
• Non-traumatic emergency department presentation
• Availability of clinical data required for early warning score calculation
• Availability of 28-day follow-up data
• Written informed consent provided by the patient or, when applicable, by a legal representative

Exclusion criteria

Participants will be excluded if they meet any of the following criteria:

• Trauma-related presentation
• Insufficient clinical data for calculation of early warning scores
• Incomplete 28-day follow-up data
• Presentation in cardiac arrest
• Death within the first hour after emergency department presentation
• Known hematologic malignancy
• Presentation for palliative support only
• Inability to obtain informed consent from the patient or a legal representative

Trial design

2,744 participants in 2 patient groups

Survivors

Description:

Survivors were defined as eligible geriatric emergency department patients who remained alive within 28 days after the index emergency department presentation.

Treatment:

Other: Vital Signs

Other: Comorbidities

Other: Clinical Frailty Scale

Other: Early Warning Scores

Other: Severity Scores

Other: Demographic Characteristics

Other: Laboratory Parameters

Non-survivors

Description:

Non-survivors were defined as eligible geriatric emergency department patients who experienced all-cause mortality within 28 days after the index emergency department presentation.

Treatment:

Other: Vital Signs

Other: Comorbidities

Other: Clinical Frailty Scale

Other: Early Warning Scores

Other: Severity Scores

Other: Demographic Characteristics

Other: Laboratory Parameters