EWSs and 28-Day Mortality in Geriatric ED Patients

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.