EWSs and 28-Day Mortality in Geriatric ED Patients

NCT07577349 | Completed DMC

• 1 other identifier: 01/2025
• Study Type: observational
• Target: 2,744
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

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

Keywords

Early warning systems; geriatric patients; 28-day mortality; frailty

Outcome Measures

Primary Outcomes (1)

• Discriminatory Performance of Early Warning Scores for 28-Day Mortality

  The prognostic performance of each early warning score for predicting 28-day all-cause mortality will be evaluated using receiver operating characteristic curve analysis. The area under the curve will be calculated for each score, including NEWS, NEWS2, MEWS, qSOFA, SIRS, REMS, HEWS, TREWS, RAPS, and CART.

  At emergency department presentation, with outcome assessment at 28 days

Secondary Outcomes (3)

• Diagnostic Performance Measures of Early Warning Score Cut-Off Values

  At emergency department presentation, with outcome assessment at 28 days

• Independent Predictors of 28-Day Mortality in Geriatric Emergency Department Patients

  At emergency department presentation, with outcome assessment at 28 days

• Effect of Frailty on 28-Day Mortality Prediction

  At emergency department presentation, with outcome assessment at 28 days

Study Arms (2)

Survivors

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

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

Non-survivors

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

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

Interventions

Demographic Characteristics OTHER

Baseline demographic characteristics were recorded at emergency department presentation. These included age and sex. Age was analyzed as a continuous variable and was also considered clinically relevant because the study population consisted of geriatric patients aged 65 years and older.

Non-survivors; Survivors

Comorbidities OTHER

Pre-existing comorbid conditions were recorded for each participant based on medical history and available clinical records at emergency department presentation. The assessed comorbidities included hypertension, diabetes mellitus, coronary artery disease, chronic kidney disease, heart failure, ischemic stroke, chronic obstructive pulmonary disease, and malignancy. Comorbidity status was evaluated as part of baseline clinical risk assessment.

Non-survivors; Survivors

Laboratory Parameters OTHER

Initial laboratory parameters obtained during emergency department evaluation were recorded. These included blood gas parameters and complete blood count results. Laboratory variables were assessed as potential predictors of 28-day all-cause mortality and were also evaluated in relation to acute physiological deterioration and metabolic stress. Parameters included, pH, partial pressure of carbon dioxide (PaCO₂, mmHg), bicarbonate (HCO₃-, mmol/L), base excess (BE, mmol/L), leukocyte count (10³/µL), and lactate level (mmol/L).

Non-survivors; Survivors

Severity Scores OTHER

Severity-related clinical scores, including Glasgow Coma Scale, quick Sequential Organ Failure Assessment, and Systemic Inflammatory Response Syndrome criteria, were calculated using data obtained at emergency department presentation or within the first hour after admission. These scores were used to assess acute illness severity and early clinical deterioration risk in geriatric emergency department patients.

Non-survivors; Survivors

Early Warning Scores OTHER

Early warning scores were calculated for each participant using clinical data obtained at emergency department presentation or within the first hour after admission. These scores were evaluated for their ability to predict 28-day all-cause mortality among geriatric patients presenting to the emergency department with non-traumatic conditions. The prognostic performance of each score was assessed using receiver operating characteristic curve analysis and diagnostic performance measures. Scores included National Early Warning Score, National Early Warning Score 2, Modified Early Warning Score, Rapid Emergency Medicine Score, Cardiac Arrest Risk Triage score, Hamilton Early Warning Score, Triage Early Warning Score, and Rapid Acute Physiology Score.

Non-survivors; Survivors

Vital Signs OTHER

Vital signs were measured at emergency department presentation or within the first hour after admission. The recorded vital signs included systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, body temperature, and peripheral oxygen saturation when available. These parameters were used both as individual clinical variables and as components of early warning score calculations.

Non-survivors; Survivors

Clinical Frailty Scale OTHER

Frailty status was assessed using the Clinical Frailty Scale at emergency department presentation. The Clinical Frailty Scale was used to evaluate baseline vulnerability and physiological reserve in older adults. Its association with 28-day all-cause mortality was examined as part of geriatric risk stratification.

Non-survivors; Survivors

Eligibility Criteria

• Age: 65 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Patients aged 65 years and older presenting to the emergency department with non-traumatic conditions who met the eligibility criteria and had complete data for early warning score calculation and 28-day follow-up.

You may qualify if:

• 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

You may not qualify if:

• 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

Sponsors & Collaborators

• Haseki Training and Research Hospital: lead

Study Sites (1)

Haseki Training and Research Hospital

Istanbul, Istanbul, 34265, Turkey (Türkiye)

Location

Related Publications (5)

• Baeyens H, Haegdorens F, Martens S, Abeele MEV, Wallaert S, Van Den Noortgate N, Brys ADH. Validation and performance of a geriatric early warning score (GEWS) versus the national early warning score (NEWS) in predicting clinical deterioration in frail older patients. Eur Geriatr Med. 2026 Apr;17(2):615-627. doi: 10.1007/s41999-025-01316-7. Epub 2025 Oct 6.

  PMID: 41047463 RESULT

• Kim I, Song H, Kim HJ, Park KN, Kim SH, Oh SH, Youn CS. Use of the National Early Warning Score for predicting in-hospital mortality in older adults admitted to the emergency department. Clin Exp Emerg Med. 2020 Mar;7(1):61-66. doi: 10.15441/ceem.19.036. Epub 2020 Mar 31.

  PMID: 32252135 RESULT

• Covino M, Sandroni C, Della Polla D, De Matteis G, Piccioni A, De Vita A, Russo A, Salini S, Carbone L, Petrucci M, Pennisi M, Gasbarrini A, Franceschi F. Predicting ICU admission and death in the Emergency Department: A comparison of six early warning scores. Resuscitation. 2023 Sep;190:109876. doi: 10.1016/j.resuscitation.2023.109876. Epub 2023 Jun 17.

  PMID: 37331563 RESULT

• Gerry S, Bonnici T, Birks J, Kirtley S, Virdee PS, Watkinson PJ, Collins GS. Early warning scores for detecting deterioration in adult hospital patients: systematic review and critical appraisal of methodology. BMJ. 2020 May 20;369:m1501. doi: 10.1136/bmj.m1501.

  PMID: 32434791 RESULT

• Guan G, Lee CMY, Begg S, Crombie A, Mnatzaganian G. The use of early warning system scores in prehospital and emergency department settings to predict clinical deterioration: A systematic review and meta-analysis. PLoS One. 2022 Mar 17;17(3):e0265559. doi: 10.1371/journal.pone.0265559. eCollection 2022.

  PMID: 35298560 RESULT

MeSH Terms

Conditions

Clinical Deterioration; Frailty

Interventions

Comorbidity; Injury Severity Score; Early Warning Score

Condition Hierarchy (Ancestors)

Disease Progression; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Epidemiologic Factors; Quality of Health Care; Health Care Quality, Access, and Evaluation; Public Health; Environment and Public Health; Trauma Severity Indices; Medical Records; Records; Data Collection; Epidemiologic Methods; Investigative Techniques; Organization and Administration; Health Services Administration; Health Care Evaluation Mechanisms; Severity of Illness Index; Patient Acuity; Health Status Indicators; Health Surveys; Surveys and Questionnaires

Study Officials

• Adem Az

  Sultangazi Haseki Eğitim ve Araştırma Hastanesi, Başhekimlik

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: May 3, 2026
• First Posted: May 11, 2026
• Study Start: July 1, 2025
• Primary Completion: January 29, 2026
• Study Completion: January 29, 2026
• Last Updated: May 11, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)