Validation and Performance of a Geriatric Early Warning Score (Gews) Versus the National Early Waring Score (News) in Predicting Clinical Deterioration in Frail Older Patients

Purpose : Early warning scores, such as the National Early Warning Score (NEWS), are less accurate in detecting clinical deterioration in frail older individuals due to age-related altered physiological responses. A Geriatric Early Warning Score (GEWS) was developed to take into account older adults’ frailty. This study aimed to validate GEWS and compare its predictive accuracy with NEWS, as well as to evaluate the clinical burden of GEWS. Methods : In this prospective multicenter observational study, patients admitted to acute geriatric wards were included. Clinical deterioration was defined as the occurrence of one of four events: (1) unexpected death, (2) ICU transfer, (3) transition to palliative care, or (4) urgent medical/surgical intervention. GEWS and NEWS were compared using C-statistics, performance and clinical burden metrics. Results : Among 511 patients, 348 events were recorded in 302 individuals. GEWS significantly outperformed NEWS across all event types, showing higher AUROC and PR-AUC values ( p <0.0001). At a GEWS threshold ≥5, predictive performance 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. GEWS ≥5 was also associated with a lower clinical burden (NNE: 2.013 vs 2.738, p <0.0001). For life-threatening events (Type 1-3), GEWS ≥8 provided higher specificity (0.999 vs. 0.995, p <0.0001) and a reduced alarm rate (0.518 vs.1.347, p <0.0001). Conclusion : GEWS offers a more accurate, geriatric-specific alternative to NEWS for detecting clinical deterioration in frail older adults, while reducing clinical workload. A threshold of GEWS ≥5 is recommended for clinical alerting, whereas ≥8 for rapid response team activation.