Validation and performance of a geriatric early warning score (GEWS) versus the national early warning score (NEWS) in predicting clinical deterioration in frail older patients

PURPOSE: A Geriatric Early Warning Score (GEWS) for detecting clinical deterioration in frail older individuals was developed to account for age-related altered physiological responses and was based on the framework of the National Early Warning Score (NEWS), expert consensus and existing literature. This study aimed to validate GEWS and compare its predictive accuracy with the NEWS, as well as to evaluate the clinical burden of predefined thresholds. METHODS: In this prospective multicenter observational study, patients receiving acute geriatric care were included. Clinical deterioration was defined as: (1) unexpected death, (2) Intensive Care Unit transfer, (3) transition to palliative care, or (4) urgent medical/surgical intervention. RESULTS: Among 511 patients, 348 events occurred in 297 individuals. We found higher AUROC 0.796 95% CI 0.770-0.822 and PR-AUC values 0.412 95% CI 0.350-0.472 for GEWS compared to NEWS 0.732 95% CI 0.697-0.765 and 0.305 95% CI 0.249-0.365 respectively (p < 0.0001). The GEWS ≥ 5 compared to NEWS ≥ 5 was superior in accuracy (0.940 vs. 0.927), PPV (0.497 vs. 0.365), and specificity (0.977 vs. 0.967), (all p < 0.0001). Moreover, a lower-number-needed-to-evaluate (NNE) (2.013 vs. 2.738, p < 0.0001) and a higher alerted-outcome-event-rate (AOER 4.424 vs. 3.706, p < 0.0005) resulted in lower clinical burden. For life-threatening events (Type 1-3), GEWS ≥ 8 compared to NEWS ≥ 7 showed higher specificity (0.999 vs. 0.995, p < 0.0001) and reduced rate-of-alerts (ROA 0.518 vs.1.347, p < 0.0001). CONCLUSION: GEWS more accurately detects clinical deterioration within 12 h in frail older adults than NEWS, with less clinical burden. GEWS ≥ 5 is recommended for clinical alerting, whereas ≥ 8 for more urgent medical assistance.