Performance of Different Early Warning Systems in Predicting 28-day Mortality Among Geriatric Emergency Department Patients
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 2,744
- 试验地点
- 1
- 主要终点
- Discriminatory Performance of Early Warning Scores for 28-Day Mortality
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •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
排除标准
- •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
研究组 & 干预措施
Survivors
Survivors were defined as eligible geriatric emergency department patients who remained alive within 28 days after the index emergency department presentation.
干预措施: Laboratory Parameters (Other)
Survivors
Survivors were defined as eligible geriatric emergency department patients who remained alive within 28 days after the index emergency department presentation.
干预措施: Demographic Characteristics (Other)
Survivors
Survivors were defined as eligible geriatric emergency department patients who remained alive within 28 days after the index emergency department presentation.
干预措施: Comorbidities (Other)
Survivors
Survivors were defined as eligible geriatric emergency department patients who remained alive within 28 days after the index emergency department presentation.
干预措施: Vital Signs (Other)
Survivors
Survivors were defined as eligible geriatric emergency department patients who remained alive within 28 days after the index emergency department presentation.
干预措施: Severity Scores (Other)
Survivors
Survivors were defined as eligible geriatric emergency department patients who remained alive within 28 days after the index emergency department presentation.
干预措施: Clinical Frailty Scale (Other)
Survivors
Survivors were defined as eligible geriatric emergency department patients who remained alive within 28 days after the index emergency department presentation.
干预措施: Early Warning Scores (Other)
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.
干预措施: Demographic Characteristics (Other)
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.
干预措施: Comorbidities (Other)
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.
干预措施: Vital Signs (Other)
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.
干预措施: Laboratory Parameters (Other)
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.
干预措施: Severity Scores (Other)
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.
干预措施: Clinical Frailty Scale (Other)
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.
干预措施: Early Warning Scores (Other)
结局指标
主要结局
Discriminatory Performance of Early Warning Scores for 28-Day Mortality
时间窗: 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.
次要结局
- 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)
研究者
Adem Az
Principal Investigator
Haseki Training and Research Hospital