Electrocardiographic Predictors for Early Risk Stratification: 30-Day Mortality in Older Adult Trauma Patients

Objectives: This prospective observational study aimed to assess the prognostic value of electrocardiographic (ECG) findings obtained at emergency department (ED) admission in adult patients presenting with trauma-related fractures, with a focus on their association with 30-day all-cause mortality. Materials and Methods: A total of 391 patients aged ≥18 years with trauma-induced fractures were enrolled at a tertiary emergency center between February and May 2025. Baseline demographic and clinical data, including comorbidities, trauma mechanisms, and 12-lead ECG findings at admission, were recorded. Patients were monitored for 30-day mortality. Logistic regression analysis was used to identify independent predictors of mortality. Results: The mean age of the patients was 73.9 ± 6.7 years, and 50.1% were female. Normal sinus rhythm was the most common ECG finding (31.5%), followed by sinus tachycardia (20.5%) and bundle branch block (15.3%), while atrial fibrillation (AF) was present in 9.5% of cases. Thirty-day mortality occurred in 5.1% of the cohort (n = 20). Non-survivors had significantly higher frequencies of AF (35.0% vs. 8.1%, p = 0.001), head trauma (70.0% vs. 18.1%, p < 0.001), cerebrovascular disease (55.0% vs. 16.4%, p < 0.001), and polypharmacy (100% vs. 62.8%, p = 0.001) compared with survivors. Conversely, low-energy falls were more common among survivors (74.7% vs. 20.0%, p < 0.001), whereas falls from stairs or a bed and high-energy trauma were significantly more frequent among non-survivors (all p < 0.05). In multivariate logistic regression, AF (OR: 6.112; 95% CI: 1.612-23.176; p = 0.008), head trauma (OR: 16.514; 95% CI: 4.925-55.367; p < 0.001), and cerebrovascular disease (OR: 6.725; 95% CI: 2.219-20.385; p = 0.001) emerged as independent predictors of 30-day mortality. Although normal sinus rhythm was associated with survival in univariate analysis (p = 0.034), it did not retain independent significance in multivariate modeling. Patients with AF had significantly lower 30-day survival compared with those without AF (65.0% vs. 96.3%, p = 0.001). Conclusions: This prospective study demonstrates that electrocardiographic abnormalities-especially atrial fibrillation-are strong predictors of 30-day mortality in older adult trauma patients. Their prognostic value was further reinforced when assessed alongside head trauma and cerebrovascular disease. These findings emphasize ECG as a rapid, practical, and noninvasive tool for early risk stratification and clinical decision-making in the emergency care of geriatric fracture patients.