Predictive Value of S-TRIAGE and NEWS Score for Early Risk Stratification in Geriatric Patients Presenting to the Emergency Department

Abstract

Background: Emergency Department (ED) visits by older adults have increased substantially worldwide. Accurate early risk stratification of geriatric patients remains challenging due to atypical presentations, frailty and multiple comorbidities. The S-TRIAGE score (Screening Tool Risk Score Assessment for the Geriatric in the Emergency Department) and the National Early Warning Score (NEWS) are two candidate tools for this purpose, yet their comparative performance in a South Asian tertiary emergency setting is not established. Objectives: To evaluate and compare the predictive accuracy of the S-TRIAGE and NEWS scores for 28-day mortality and life-saving intervention requirements among geriatric patients presenting to the ED. Methods: A prospective cohort study was conducted at the Emergency Department of SRIHER, Chennai, from September 2025 to February 2026. Adult patients aged ≥65 years were enrolled consecutively. Patients with cardiac arrest, trauma, do-not-resuscitate orders or who left against medical advice were excluded. S-TRIAGE and NEWS scores were calculated at triage. The primary outcome was 28-day all-cause mortality. Discriminative performance was assessed using receiver operating characteristic (ROC) curve analysis; chi-square tests evaluated association with outcome. Results: A total of 349 patients were analysed (mean age 65–75 years; 61.0% male). Twenty-eight-day mortality was 22.1% (n = 77). S-TRIAGE achieved an area under the ROC curve (AUC) of 0.73 (sensitivity 75%, specificity 70%), compared with AUC 0.66 for NEWS (sensitivity 50%, specificity 75%). Both scores were significantly associated with 28-day mortality (χ² = 38.85 and 61.28, respectively; p < 0.001). S-TRIAGE very-high-risk category (score >10) carried 85.7% mortality, while NEWS high-risk category (≥7) carried 43.8% mortality. ICU admission was required in 78.2% of patients. Conclusion: S-TRIAGE demonstrated superior sensitivity and overall discriminative ability compared with NEWS for 28-day mortality prediction in geriatric ED patients. Its incorporation of geriatric-specific clinical parameters enhances risk stratification and may support earlier escalation of care in this vulnerable population.