Unmasking Risk in the Elderly: Predictors of Emergency Department Outcomes and the Role of Early Warning Score

The growing proportion of older adults worldwide has led to increasing utilization of Emergency Department (ED) services. In Indonesia, where the elderly population continues to expand rapidly, contemporary data on geriatric characteristics and outcomes in the ED remain limited.

This study primarily aimed to identify determinants of prolonged ED length of stay (EDLOS ≥ 4 h), 90-day unplanned ED re-admission and mortality. Secondary objective was to evaluate the diagnostic performance of various severity scoring systems in ED.

A retrospective review was conducted using medical records of patients aged ≥ 60 years who presented to the ED of a secondary hospital between January and June 2025. Data collected included demographics, comorbidities, functional status, frailty, polypharmacy, nutritional status, triage category, clinical presentation, scoring assessments (REMS, HOTEL, NEWS2, APACHE-II). Logistic regression analyses were used to identify predictors and ROC analyses assessed scoring system performance.

A total of 1433 geriatric patients were analyzed. Prolonged EDLOS occurred in 53.24% of patients, with independent predictors including specialist consultation, atypical clinical condition, delirium, malnutrition, frailty, and functional decline. The 90-day mortality rate was 11.58%, and the 90-day re-admission rate was 14%. Delirium, frailty, comorbidity burden (CCI ≥ 2), functional decline, and ICU admission were consistent predictors of adverse outcomes. Among the scoring tools, APACHE-II demonstrated the highest predictive accuracy for 90-day mortality, followed by REMS.

Geriatric patients in the ED face a high prevalence of prolonged EDLOS and significant risk of adverse 90-day outcomes. These outcomes are strongly associated with atypical clinical conditions, delirium, malnutrition, frailty, functional decline, and high comorbidity burden.