European Geriatric Emergency Departments Registry Study (EGERS)

December 21, 2020 updated by: Mehmet Akif Karamercan, Gazi University
Geriatric presentations to emergency services comprise a significant percentage of all emergency service presentations in Europe and it has been reported that 3-23% of all emergency service presentations from various regions of the countries. There are specific management practices for patients who are 65 years and older at emergency services. On the other hand several risk-scoring systems have been developed to define the severity class of the patient during their initial evaluation at emergency services.Only a few studies in the literature have evaluated risk-scoring systems for the geriatric patient group.Several studies have reported that risk-scoring systems, such as Identification of Seniors at Risk and Triage Risk Screening Tool, which are specifically developed for geriatric patients over 65 years who present to emergency services, are not sufficiently effective for evaluating patients in more severe conditions. Previously the TEDGeS (Turkish Emergency Departments Geriatric Scoring Study) pilot study was carried out and published by some of the investigators of this project.This pilot study enrolled all geriatric patients (age ≥ 65 years) and carried out in 13 centers from different cities of Turkey. This pilot study showed that geriatric patients not only constitute significant proportion of emergency department presentations but also these patients need more hospitalization. The predictive powers of the Modified Early Warning Score, Rapid Emergency Medicine Score and The Vital PAC Early Warning Score for hospitalization and mortality in geriatric patients those presented to emergency department are significantly high and might be concerned in the emergency department triage of these patients. Within the light of these pilot study results, the investigators have decided to execute this prospective, multinational, multicentric study with the main objective to determine the epidemiological and age related characteristics of geriatric patients presenting to the emergency department across Europe and evaluate early warning scoring systems systems regarding hospitalization, ICU admission and in-hospital mortality for geriatric patients.

Study Overview

Status

Unknown

Conditions

Detailed Description

Due to improved prevention, diagnosis and treatment modalities, life expectancy worldwide has risen. The number of adults over 65 years of age who are presenting to emergency services is increasing in parallel with the prolongation of the average life expectancy. While geriatric presentations to emergency services comprise 40-50% of all emergency service presentations in the U.S., it has been reported that 3-23% of all emergency service presentations from various regions of the country comprise patients of 65 years of age and older. There are specific management practices for patients who are 65 years and older at emergency services due to the presence of co-morbidities and the change of physiological responses to acute diseases in advanced age.

Several risk-scoring systems have been developed to define the severity class of the patient during their initial evaluation at emergency services and generally named as Early Warning Scores. Early Warning Scores (EWS) incorporate physiological measurements, which do predict outcome although the addition of other simple clinical parameters might further improve the sensitivity and specificity of these scores. On the other hand all these EWS are simple and easy to calculate, making their use appropriate in an emergency setting. Of these EWS, the Modified Early Warning Score (MEWS), and the Rapid Emergency Medicine Score (REMS) have been widely used for many years (8) and The Vital PAC Early Warning Score (VIEWS) score was recently developed for the same purpose.

Only a few studies in the literature have evaluated risk-scoring systems for the geriatric patient group. Several studies have reported that risk-scoring systems, such as Identification of Seniors at Risk (ISAR) and Triage Risk Screening Tool (TRST), which are specifically developed for geriatric patients over 65 years who present to emergency services, are not sufficiently effective for evaluating patients in more severe conditions. Other studies have reported that the ESI triage classification predicts the prognosis correctly in only half of the patients over 65 years of age. In another study that evaluated the MEWS for the geriatric patient group, which was calculated during the presentation in emergency services, has been stated to have a prognostic value in terms of a poor result.

Previously the TEDGeS (Turkish Emergency Departments Geriatric Scoring Study) pilot study was carried out and published. This study enrolled all geriatric patients (age ≥ 65 years) and carried out in 13 centers (University Hospitals, Government Education and Research Hospitals and Military Hospital Emergency Departments) from different cities of Turkey.

Key findings were:

  • Overall 30 % of hospitalized patients from Emergency Department (ED) are elderly patients and 30 % of these hospitalized patients were ICU hospitalizations
  • In hospital mortality rate is about 6 % which is very high for general hospitalized patients
  • The most common presenting symptoms are related to gastrointestinal systems and about 80 % of the cases using at least one chronic medication (22.2 % of the cases using more than 4 chronic medications
  • About 45 % of the cases final diagnosis are related to cardiovascular system and gastrointestinal system and nearly 85 % of the hospitalized cases are treated in non-surgical clinics (cardiology-pulmonology-internal medicine 65 %)
  • MEWS, VIEWS and REMS scores are significantly high in hospitalized patients compared to discharged from ED and also these three scores are high in ICU hospitalized patients compared to both ward hospitalized and discharged patients.
  • MEWS, VIEWS and REMS scores are significantly high in non-survivors compared to survivors.
  • MEWS, VIEWS scores has higher sensitivity and specificity in terms of in-hospital mortality

These results suggest that geriatric patients not only constitute significant proportion of ED presentations but also they need more hospitalization. The predictive powers of the MEWS, VIEWS and REMS scores for hospitalization and mortality in geriatric patients those presented to ED are significantly high and might be concerned in the ED triage of these patients.

Within the light of these results this multinational, multicentric, prospective, non interventional, observational study on geriatric patients presented to ED. The main objective is 'To determine Epidemiologic and Age Related Characteristics of Geriatric Patients presenting to the ED across Europe' and secondary objectives are 'To evaluate Early Warning Scoring systems (REMS, MEWS and VIEWS Scores) and determine most suitable Geriatric Emergency Medicine Risk Score regarding hospitalization, ICU admission and in-hospital mortality for patients; To determine the most effective triage elements that can be used to predict hospitalization of geriatric patients presented to ED; To determine the in hospital mortality and short term mortality rates of the patients above 65 years of age presenting to the ED across Europe; Sub analysis of ED discharged patients versus admitted patients for characteristics, comparison to recommended care and re-ED visit; Comparison of European data characteristics, investigation, treatment and outcome to similar data in other part of the world.

Study Type

Observational

Enrollment (Anticipated)

3000

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Croatia
      • Zagreb, Croatia, 10 000
  • France
      • Tours, France, 37170
  • Germany
    • Duitsland
      • Berlin, Duitsland, Germany, 10117
  • Greece
    • Griekenland
      • Chaïdári, Griekenland, Greece, 12462
        • Recruiting
        • University General Hospital ATTIKONi
        • Contact:
  • Ireland
      • Dublin, Ireland, A96D628
        • Recruiting
        • St Michael's Hospital
        • Contact:
  • Turkey
      • Ankara, Turkey, 06580
        • Recruiting
        • Gazi University
        • Contact:
      • Konya, Turkey, 42080
        • Recruiting
        • Necmettin Erbakan University Meram Medical Faculty
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

65 years to 110 years (Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Probability Sample

Study Population

Patients ≥ 65 years of age those presented to Emergency Departments with any symptom during the recruitment period of the study

Description

Inclusion Criteria:

  • Consecutive geriatric patient presenting to the ED with any symptom
  • 65 years or older

Exclusion Criteria:

  • No acceptance to participated to the study
  • End of life patients

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Cohort
  • Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Medical history and co-morbidities
Time Frame: Baseline
Listing of medical history and co-morbidities data provided by triage nurse, physician and the family during emergency department admission
Baseline

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Length of Emergency Department stay
Time Frame: Up to 96 hours after registration to the ED
Continuous outcome measured via the Patient Electronic Medical records defined in hours, measured from patient ED triage registration till discharged or hospitalized from ED.
Up to 96 hours after registration to the ED
Length of Hospital stay
Time Frame: 30 days after recruitment
Continuous outcome measured via the Patient Electronic Medical records defined in Days, measured from admission to hospital wards or ICU date till discharge or death.
30 days after recruitment
In Hospital Mortality
Time Frame: 30 days after recruitment
Hospital mortality of geriatric patients admitted to hospital wards or ICU from emergency department
30 days after recruitment

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Gazi University

Collaborators

European Society for Emergency Medicine (EUSEM) Research Network

Investigators

  • Principal Investigator: Said Laribi, MD., CHU Tours
  • Principal Investigator: Effie Polyzogopoulou, MD., University General Hospital Attikon
  • Principal Investigator: Kelly Janssens, MD., Unity Health Toronto
  • Principal Investigator: Anna Slagman, MD., UKSH Campus Kiel
  • Study Chair: Mehmet A. Karamercan, MD., Gazi University Faculty of Medicine
  • Study Chair: Zerrin D. Dundar, MD, Necmettin Erbakan University Meram Medicine Faculty

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

October 15, 2020

Primary Completion (Anticipated)

February 21, 2021

Study Completion (Anticipated)

October 1, 2021

Study Registration Dates

First Submitted

December 7, 2020

First Submitted That Met QC Criteria

December 21, 2020

First Posted (Actual)

December 22, 2020

Study Record Updates

Last Update Posted (Actual)

December 22, 2020

Last Update Submitted That Met QC Criteria

December 21, 2020

Last Verified

December 1, 2020

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • EUSEM-1

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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