European Geriatric Emergency Departments Registry Study
NCT ID: NCT04680299
Last Updated: 2020-12-22
Study Results
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Basic Information
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UNKNOWN
3000 participants
OBSERVATIONAL
2020-10-15
2021-10-01
Brief Summary
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Detailed Description
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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.
Conditions
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Keywords
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Study Design
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COHORT
PROSPECTIVE
Eligibility Criteria
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Inclusion Criteria
* 65 years or older
Exclusion Criteria
* End of life patients
65 Years
110 Years
ALL
No
Sponsors
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European Society for Emergency Medicine (EUSEM) Research Network
NETWORK
Gazi University
OTHER
Responsible Party
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Mehmet Akif Karamercan
Chair of Education and Fellowship Programme, Assoc. Prof.
Principal Investigators
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Said Laribi, MD.
Role: PRINCIPAL_INVESTIGATOR
CHU Tours
Effie Polyzogopoulou, MD.
Role: PRINCIPAL_INVESTIGATOR
University General Hospital ATTIKON
Kelly Janssens, MD.
Role: PRINCIPAL_INVESTIGATOR
Unity Health Toronto
Anna Slagman, MD.
Role: PRINCIPAL_INVESTIGATOR
UKSH Campus Kiel
Mehmet A. Karamercan, MD.
Role: STUDY_CHAIR
Gazi University Faculty of Medicine
Zerrin D. Dundar, MD
Role: STUDY_CHAIR
Necmettin Erbakan University Meram Medicine Faculty
Locations
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Clinical Hospital Sveti Duh
Zagreb, , Croatia
CHU Tours
Tours, , France
Charité Universitätsmedizin
Berlin, Duitsland, Germany
University General Hospital ATTIKONi
Chaïdári, Griekenland, Greece
St Michael's Hospital
Dublin, , Ireland
Gazi University
Ankara, , Turkey (Türkiye)
Necmettin Erbakan University Meram Medical Faculty
Konya, , Turkey (Türkiye)
Countries
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Central Contacts
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Facility Contacts
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Višnja Nesek, MD.
Role: primary
Said Laribi, MD
Role: primary
Anna Slagman, MD
Role: primary
Effie Polyzogopoulou, MD.
Role: primary
Kelly Janssens, MD.
Role: primary
Mehmet A. Karamercan, MD.
Role: primary
Zerrin D. Dundar, MD
Role: primary
References
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Dundar ZD, Ergin M, Karamercan MA, Ayranci K, Colak T, Tuncar A, Cander B, Gul M. Modified Early Warning Score and VitalPac Early Warning Score in geriatric patients admitted to emergency department. Eur J Emerg Med. 2016 Dec;23(6):406-412. doi: 10.1097/MEJ.0000000000000274.
Cei M, Bartolomei C, Mumoli N. In-hospital mortality and morbidity of elderly medical patients can be predicted at admission by the Modified Early Warning Score: a prospective study. Int J Clin Pract. 2009 Apr;63(4):591-5. doi: 10.1111/j.1742-1241.2008.01986.x. Epub 2009 Feb 11.
Dundar ZD, Ayranci MK. Presenting symptoms of older emergency department patients: a single-center experience of 10,692 patients in Turkey. Acta Clin Belg. 2020 Dec;75(6):405-410. doi: 10.1080/17843286.2019.1655215. Epub 2019 Aug 12.
Lamantia MA, Stewart PW, Platts-Mills TF, Biese KJ, Forbach C, Zamora E, McCall BK, Shofer FS, Cairns CB, Busby-Whitehead J, Kizer JS. Predictive value of initial triage vital signs for critically ill older adults. West J Emerg Med. 2013 Sep;14(5):453-60. doi: 10.5811/westjem.2013.5.13411.
Buurman BM, van den Berg W, Korevaar JC, Milisen K, de Haan RJ, de Rooij SE. Risk for poor outcomes in older patients discharged from an emergency department: feasibility of four screening instruments. Eur J Emerg Med. 2011 Aug;18(4):215-20. doi: 10.1097/MEJ.0b013e328344597e.
Pines JM, Mullins PM, Cooper JK, Feng LB, Roth KE. National trends in emergency department use, care patterns, and quality of care of older adults in the United States. J Am Geriatr Soc. 2013 Jan;61(1):12-7. doi: 10.1111/jgs.12072.
Platts-Mills TF, Travers D, Biese K, McCall B, Kizer S, LaMantia M, Busby-Whitehead J, Cairns CB. Accuracy of the Emergency Severity Index triage instrument for identifying elder emergency department patients receiving an immediate life-saving intervention. Acad Emerg Med. 2010 Mar;17(3):238-43. doi: 10.1111/j.1553-2712.2010.00670.x.
Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM. 2001 Oct;94(10):521-6. doi: 10.1093/qjmed/94.10.521.
Wheeler I, Price C, Sitch A, Banda P, Kellett J, Nyirenda M, Rylance J. Early warning scores generated in developed healthcare settings are not sufficient at predicting early mortality in Blantyre, Malawi: a prospective cohort study. PLoS One. 2013;8(3):e59830. doi: 10.1371/journal.pone.0059830. Epub 2013 Mar 29.
Provided Documents
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Document Type: Study Protocol, Statistical Analysis Plan, and Informed Consent Form
Other Identifiers
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EUSEM-1
Identifier Type: -
Identifier Source: org_study_id