{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:49:30Z","timestamp":1787845770378,"version":"build-2784847793"},"reference-count":38,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: In older and frail patients, in-hospital cardiac arrest (IHCA) is associated with high mortality. Early warning scores such as the National Early Warning Score 2 (NEWS2) are widely used to detect clinical deterioration, but their predictive accuracy in frail populations remains uncertain. This study aimed to assess whether integrating frailty measures with NEWS2 could better describe elderly IHCA patients. Materials and Methods: We conducted a single-center, retrospective observational study in adult and frail patients (\u226518 years) admitted to medical and surgical wards of the University Hospital of Siena who experienced IHCA between January 2022 and January 2024. Data on demographics, such as last NEWS2 before IHCA, Clinical Frailty Scale (CFS), Barthel Index (BI), and Charlson Comorbidity Index (CCI) were retrospectively collected and analyzed. Patients were stratified into three categories, according to NEWS2: Stable (A), Potentially Unstable or Unstable (B), and Critical (C). Results: Seventy patients were analyzed (mean age 76.9 \u00b1 11.0 years; 56% male). The mean pre-IHCA NEWS2 score was 6.0 \u00b1 3.5, with 41% of patients classified as NEWS2-C, 48% classified as NEWS2-B, and 11% classified as NEWS2-A. The NEWS2-A category showed higher BI and lower CFS than NEWS2-B and NEWS2-C (p &lt; 0.01), while CCI and age did not significantly differ. Conclusions: The association of NEWS2 with frailty scores could identify some elderly patients with limited pre-arrest physiological derangements but high frailty who suffered from IHCA. These findings provide descriptive insights that may inform monitoring strategies for \u201cat-risk\u201d elderly patients to help prevent IHCA.<\/jats:p>","DOI":"10.3390\/medicina62020311","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T15:38:12Z","timestamp":1770046692000},"page":"311","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Combining the National Early Warning Score 2 with Frailty Assessment to Identify Patients at Risk of In-Hospital Cardiac Arrest: A Descriptive Exploratory Study"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7315-8273","authenticated-orcid":false,"given":"Cesare","family":"Biuzzi","sequence":"first","affiliation":[{"name":"Urgency-Emergency Anesthesia and Intensive Care Unit, Department of Medical Science, Surgery and Neurosciences, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Modica","sequence":"additional","affiliation":[{"name":"Urgency-Emergency Anesthesia and Intensive Care Unit, Department of Medical Science, Surgery and Neurosciences, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Vozza","sequence":"additional","affiliation":[{"name":"Urgency-Emergency Anesthesia and Intensive Care Unit, Department of Medical Science, Surgery and Neurosciences, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Gargiuli","sequence":"additional","affiliation":[{"name":"Urgency-Emergency Anesthesia and Intensive Care Unit, Department of Medical Science, Surgery and Neurosciences, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetta","family":"Galgani","sequence":"additional","affiliation":[{"name":"Urgency-Emergency Anesthesia and Intensive Care Unit, Department of Medical Science, Surgery and Neurosciences, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Coratti","sequence":"additional","affiliation":[{"name":"Urgency-Emergency Anesthesia and Intensive Care Unit, Department of Medical Science, Surgery and Neurosciences, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Marianello","sequence":"additional","affiliation":[{"name":"Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, Department of Medical Science, Surgery and Neurosciences, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio Silvio","family":"Taccone","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, H\u00f4pital Universitaire de Bruxelles (HUB), Universit\u00e9 Libre de Bruxelles (ULB), 1070 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4448-1892","authenticated-orcid":false,"given":"Federico","family":"Franchi","sequence":"additional","affiliation":[{"name":"Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, Department of Medical Science, Surgery and Neurosciences, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3709-2052","authenticated-orcid":false,"given":"Sabino","family":"Scolletta","sequence":"additional","affiliation":[{"name":"Urgency-Emergency Anesthesia and Intensive Care Unit, Department of Medical Science, Surgery and Neurosciences, University Hospital of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"ref_1","unstructured":"(2025, September 15). Eurostat EU Median Age Increased by 2.3 Years Since 2013. Available online: https:\/\/ec.europa.eu\/eurostat\/web\/products-eurostat-news\/w\/ddn-20240215-1."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.resuscitation.2019.12.042","article-title":"Survival after Out-of-Hospital Cardiac Arrest in Europe\u2014Results of the EuReCa TWO Study","volume":"148","author":"Wnent","year":"2020","journal-title":"Resuscitation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2350","DOI":"10.1097\/CCM.0000000000000512","article-title":"Short- and Long-Term Outcome in Elderly Patients After Out-of-Hospital Cardiac Arrest: A Cohort Study*","volume":"42","author":"Grimaldi","year":"2014","journal-title":"Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"383","DOI":"10.30574\/ijsra.2024.11.1.0067","article-title":"Demographic Shifts and Healthcare: A Review of Aging Populations and Systemic Challenges","volume":"11","author":"Muonde","year":"2024","journal-title":"Int. J. Sci. Res. Arch."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.resuscitation.2021.02.007","article-title":"European Resuscitation Council Guidelines 2021: Epidemiology of Cardiac Arrest in Europe","volume":"161","author":"Herlitz","year":"2021","journal-title":"Resuscitation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1001\/jama.2019.1696","article-title":"In-Hospital Cardiac Arrest: A Review","volume":"321","author":"Andersen","year":"2019","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.resuscitation.2019.08.021","article-title":"Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Template for In-Hospital Cardiac Arrest","volume":"144","author":"Nolan","year":"2019","journal-title":"Resuscitation"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Guan, G., Lee, C.M.Y., Begg, S., Crombie, A., and Mnatzaganian, G. (2022). The Use of Early Warning System Scores in Prehospital and Emergency Department Settings to Predict Clinical Deterioration: A Systematic Review and Meta-Analysis. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0265559"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"499","DOI":"10.7861\/clinmed.2022-news-concept","article-title":"The National Early Warning Score: From Concept to NHS Implementation","volume":"22","author":"Williams","year":"2022","journal-title":"Clin. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"55","DOI":"10.7861\/clinmed.2019-0137","article-title":"In-Hospital Cardiac Arrest and Preceding National Early Warning Score (NEWS): A Retrospective Case-Control Study","volume":"20","author":"Molt","year":"2020","journal-title":"Clin. Med."},{"key":"ref_11","unstructured":"Royal College of Physicians (2017). National Early Warning Score (NEWS) 2: Standardising the Assessment of Acute-Illness Severity in the NHS, RCP. Available online: https:\/\/www.rcp.ac.uk\/media\/a4ibkkbf\/news2-final-report_0_0.pdf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e019268","DOI":"10.1136\/bmjopen-2017-019268","article-title":"Early Warning Scores for Detecting Deterioration in Adult Hospital Patients: A Systematic Review Protocol","volume":"7","author":"Gerry","year":"2017","journal-title":"BMJ Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.resuscitation.2007.12.004","article-title":"Review and Performance Evaluation of Aggregate Weighted \u2018Track and Trigger\u2019 Systems","volume":"77","author":"Smith","year":"2008","journal-title":"Resuscitation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"100788","DOI":"10.1016\/j.resplu.2024.100788","article-title":"Physiological Deterioration Prior to In-Hospital Cardiac Arrest: What Does the National Early Warning Score-2 Miss?","volume":"20","author":"Gonem","year":"2024","journal-title":"Resusc. Plus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.1097\/CCM.0000000000002000","article-title":"A Comparison of the Ability of the Physiologic Components of Medical Emergency Team Criteria and the U.K. National Early Warning Score to Discriminate Patients at Risk of a Range of Adverse Clinical Outcomes*","volume":"44","author":"Smith","year":"2016","journal-title":"Crit. Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1016\/S0140-6736(12)62167-9","article-title":"Frailty in Elderly People","volume":"381","author":"Clegg","year":"2013","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1503\/cmaj.050051","article-title":"A Global Clinical Measure of Fitness and Frailty in Elderly People","volume":"173","author":"Rockwood","year":"2005","journal-title":"Can. Med. Assoc. J."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Church, S., Rogers, E., Rockwood, K., and Theou, O. (2020). A Scoping Review of the Clinical Frailty Scale. BMC Geriatr, 20.","DOI":"10.1186\/s12877-020-01801-7"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1253\/circrep.CR-24-0009","article-title":"Usefulness of Clinical Frailty Scale for Comprehensive Geriatric Assessment of Older Heart Failure Patients","volume":"6","author":"Yuguchi","year":"2024","journal-title":"Circ. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3554","DOI":"10.1007\/s11606-021-07199-1","article-title":"Frailty and Survival After In-Hospital Cardiopulmonary Resuscitation","volume":"37","author":"Hu","year":"2022","journal-title":"J. Gen. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"109766","DOI":"10.1016\/j.resuscitation.2023.109766","article-title":"Prognostic Association Between Frailty and Post-Arrest Health Outcomes in Patients Receiving Home Care: A Population-Based Retrospective Cohort Study","volume":"187","author":"Mowbray","year":"2023","journal-title":"Resuscitation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.ejim.2016.08.033","article-title":"Clinical Frailty Adds to Acute Illness Severity in Predicting Mortality in Hospitalized Older Adults: An Observational Study","volume":"35","author":"Wallis","year":"2016","journal-title":"Eur. J. Intern. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1093\/ageing\/afx019","article-title":"Frailty Identification in the Emergency Department\u2014A Systematic Review Focussing on Feasibility","volume":"46","author":"Elliott","year":"2017","journal-title":"Age Ageing"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"61","author":"Altman","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1038\/s41415-020-2024-6","article-title":"Using National Early Warning Score (NEWS) 2 to Help Manage Medical Emergencies in the Dental Practice","volume":"229","author":"Jevon","year":"2020","journal-title":"Br. Dent. J."},{"key":"ref_26","unstructured":"(2025, September 15). Regione Toscana Linee di Indirizzo Regionali per la Gestione Delle Emergenze Intraospedaliere. Available online: https:\/\/www.regione.toscana.it\/documents\/10180\/16235158\/Linee+di+indirizzo+Emergenze+intraospedaliere.pdf\/bbe753d6-3961-4667-855e-c046e86a1a9b."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"105718","DOI":"10.1016\/j.jamda.2025.105718","article-title":"Associations Between Frailty, Illness Severity, and Long-Term Mortality Among Older Adults Admitted to Municipal Acute Care","volume":"26","author":"Wyller","year":"2025","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"R\u00f8nningen, P.S., Walle-Hansen, M.M., Ihle-Hansen, H., Andersen, E.L., Tveit, A., and Myrstad, M. (2023). Impact of Frailty on the Performance of the National Early Warning Score 2 to Predict Poor Outcome in Patients Hospitalised Due to COVID-19. BMC Geriatr., 23.","DOI":"10.1186\/s12877-023-03842-0"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1056\/NEJMra2301292","article-title":"Frailty in Older Adults","volume":"391","author":"Kim","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"100191","DOI":"10.1016\/j.resplu.2021.100191","article-title":"The Predictive Power of the National Early Warning Score (NEWS) 2, as Compared to NEWS, among Patients Assessed by a Rapid Response Team: A Prospective Multi-Centre Trial","volume":"9","author":"Rawshani","year":"2022","journal-title":"Resusc. Plus"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Kemp, K., Alakare, J., Harjola, V.-P., Strandberg, T., Tolonen, J., Lehtonen, L., and Castr\u00e9n, M. (2020). National Early Warning Score 2 (NEWS2) and 3-Level Triage Scale as Risk Predictors in Frail Older Adults in the Emergency Department. BMC Emerg. Med., 20.","DOI":"10.1186\/s12873-020-00379-y"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Baeyens, H., Haegdorens, F., Martens, S., Abeele, M.E.V., Wallaert, S., Van Den Noortgate, N., and Brys, A.D.H. (2025). 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. Eur. Geriatr. Med., 16.","DOI":"10.1007\/s41999-025-01316-7"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"509","DOI":"10.7861\/clinmed.2022-0435","article-title":"Using NEWS2: An Essential Component of Reliable Clinical Assessment","volume":"22","author":"Welch","year":"2022","journal-title":"Clin. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"12584","DOI":"10.1038\/s41598-025-97764-z","article-title":"The Clinical Frailty Scale Improves Risk Prediction in Older Emergency Department Patients: A Comparison with qSOFA, NEWS2, and REMS","volume":"15","author":"Chung","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"522","DOI":"10.7861\/clinmed.2022-0426","article-title":"NEWS2 and the Older Person","volume":"22","author":"Vardy","year":"2022","journal-title":"Clin. Med."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Lo Conte, S., Fruscoloni, G., Cartocci, A., Vitiello, M., De Marco, M.F., Cevenini, G., and Barbini, P. (2025). Development and Validation of a NEWS2-Enhanced Multivariable Prediction Model for Clinical Deterioration and In-Hospital Mortality in Hospitalized Adults. Medicina, 61.","DOI":"10.3390\/medicina61091543"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e13244","DOI":"10.1002\/emp2.13244","article-title":"Addition of the Clinical Frailty Scale to Triage Tools and Early Warning Scores Improves Mortality Prognostication at 30 Days: A Prospective Observational Multicenter Study","volume":"5","author":"Wretborn","year":"2024","journal-title":"J. Am. Coll. Emerg. Physicians Open"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"AB100","DOI":"10.1016\/j.jaci.2021.12.351","article-title":"Charlson Comorbidity Index and National Early Warning Score 2: Predictors of Mortality in COVID-19 Hospitalizations","volume":"149","author":"Majzoub","year":"2022","journal-title":"J. Allergy Clin. Immunol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/2\/311\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T12:54:05Z","timestamp":1770728045000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/2\/311"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":38,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["medicina62020311"],"URL":"https:\/\/doi.org\/10.3390\/medicina62020311","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]}}}