European Geriatric Emergency Departments Registry Study

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.

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.

Eligibility Criteria:
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