EWSs and 28-Day Mortality in Geriatric ED Patients (EWSsGer)
2026년 5월 3일 업데이트: Adem Az, Haseki Training and Research Hospital
Performance of Different Early Warning Systems in Predicting 28-day Mortality Among Geriatric Emergency Department Patients
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.
연구 개요
상태
완전한
상세 설명
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.
연구 유형
관찰
등록 (실제)
2744
연락처 및 위치
이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.
연구 장소
-
-
Istanbul
-
Istanbul, Istanbul, 터키 (Türkiye), 34265
- Haseki Training and Research Hospital
-
-
참여기준
연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.
자격 기준
공부할 수 있는 나이
- 고령자
건강한 자원 봉사자를 받아들입니다
아니
샘플링 방법
확률 샘플
연구 인구
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.
설명
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
공부 계획
이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.
연구는 어떻게 설계됩니까?
디자인 세부사항
코호트 및 개입
그룹/코호트 |
개입 / 치료 |
|---|---|
|
Survivors
Survivors were defined as eligible geriatric emergency department patients who remained alive within 28 days after the index emergency department presentation.
|
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.
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.
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.
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).
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.
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.
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
Non-survivors were defined as eligible geriatric emergency department patients who experienced all-cause mortality within 28 days after the index emergency department presentation.
|
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.
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.
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.
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).
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.
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.
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.
|
연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
|
Discriminatory Performance of Early Warning Scores for 28-Day Mortality
기간: At emergency department presentation, with outcome assessment at 28 days
|
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
|
2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
|
Diagnostic Performance Measures of Early Warning Score Cut-Off Values
기간: At emergency department presentation, with outcome assessment at 28 days
|
Sensitivity, specificity, positive predictive value, and negative predictive value will be calculated for relevant cut-off values of the evaluated early warning scores for predicting 28-day all-cause mortality.
|
At emergency department presentation, with outcome assessment at 28 days
|
|
Independent Predictors of 28-Day Mortality in Geriatric Emergency Department Patients
기간: At emergency department presentation, with outcome assessment at 28 days
|
The independent association of demographic variables, comorbidities, frailty, vital signs, laboratory parameters, and early warning scores with 28-day all-cause mortality will be assessed using multivariable logistic regression analysis.
|
At emergency department presentation, with outcome assessment at 28 days
|
|
Effect of Frailty on 28-Day Mortality Prediction
기간: At emergency department presentation, with outcome assessment at 28 days
|
Frailty will be assessed using the Clinical Frailty Scale, and its association with 28-day all-cause mortality will be evaluated.
The incremental clinical relevance of frailty in geriatric risk stratification will also be explored.
|
At emergency department presentation, with outcome assessment at 28 days
|
공동 작업자 및 조사자
여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.
수사관
- 수석 연구원: Adem Az, Sultangazi Haseki Eğitim ve Araştırma Hastanesi, Başhekimlik
간행물 및 유용한 링크
연구에 대한 정보 입력을 담당하는 사람이 자발적으로 이러한 간행물을 제공합니다. 이것은 연구와 관련된 모든 것에 관한 것일 수 있습니다.
일반 간행물
- 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.
- 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.
- 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.
- 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.
- 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.
연구 기록 날짜
이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.
연구 주요 날짜
연구 시작 (실제)
2025년 7월 1일
기본 완료 (실제)
2026년 1월 29일
연구 완료 (실제)
2026년 1월 29일
연구 등록 날짜
최초 제출
2026년 5월 3일
QC 기준을 충족하는 최초 제출
2026년 5월 3일
처음 게시됨 (실제)
2026년 5월 11일
연구 기록 업데이트
마지막 업데이트 게시됨 (실제)
2026년 5월 11일
QC 기준을 충족하는 마지막 업데이트 제출
2026년 5월 3일
마지막으로 확인됨
2026년 5월 1일
추가 정보
이 연구와 관련된 용어
추가 관련 MeSH 약관
기타 연구 ID 번호
- 01/2025
개별 참가자 데이터(IPD) 계획
개별 참가자 데이터(IPD)를 공유할 계획입니까?
아니요
IPD 계획 설명
Stored in non-publicly avaliableAvaliable on request
약물 및 장치 정보, 연구 문서
미국 FDA 규제 의약품 연구
아니
미국 FDA 규제 기기 제품 연구
아니
이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .