Electrocardiographic Predictors for Early Risk Stratification: 30-Day Mortality in Older Adult Trauma Patients.

Objectives

This prospective observational study aimed to assess the prognostic value of electrocardiographic (ECG) findings obtained at emergency department (ED) admission in adult patients presenting with trauma-related fractures, with a focus on their association with 30-day all-cause mortality. Materials and

Methods

A total of 391 patients aged ≥18 years with trauma-induced fractures were enrolled at a tertiary emergency center between February and May 2025. Baseline demographic and clinical data, including comorbidities, trauma mechanisms, and 12-lead ECG findings at admission, were recorded. Patients were monitored for 30-day mortality. Logistic regression analysis was used to identify independent predictors of mortality.

Results

The mean age of the patients was 73.9 ± 6.7 years, and 50.1% were female. Normal sinus rhythm was the most common ECG finding (31.5%), followed by sinus tachycardia (20.5%) and bundle branch block (15.3%), while atrial fibrillation (AF) was present in 9.5% of cases. Thirty-day mortality occurred in 5.1% of the cohort (n = 20). Non-survivors had significantly higher frequencies of AF (35.0% vs. 8.1%, p = 0.001), head trauma (70.0% vs. 18.1%, p < 0.001), cerebrovascular disease (55.0% vs. 16.4%, p < 0.001), and polypharmacy (100% vs. 62.8%, p = 0.001) compared with survivors. Conversely, low-energy falls were more common among survivors (74.7% vs. 20.0%, p < 0.001), whereas falls from stairs or a bed and high-energy trauma were significantly more frequent among non-survivors (all p < 0.05). In multivariate logistic regression, AF (OR: 6.112; 95% CI: 1.612-23.176; p = 0.008), head trauma (OR: 16.514; 95% CI: 4.925-55.367; p < 0.001), and cerebrovascular disease (OR: 6.725; 95% CI: 2.219-20.385; p = 0.001) emerged as independent predictors of 30-day mortality. Although normal sinus rhythm was associated with survival in univariate analysis (p = 0.034), it did not retain independent significance in multivariate modeling. Patients with AF had significantly lower 30-day survival compared with those without AF (65.0% vs. 96.3%, p = 0.001).

Conclusions

This prospective study demonstrates that electrocardiographic abnormalities-especially atrial fibrillation-are strong predictors of 30-day mortality in older adult trauma patients. Their prognostic value was further reinforced when assessed alongside head trauma and cerebrovascular disease. These findings emphasize ECG as a rapid, practical, and noninvasive tool for early risk stratification and clinical decision-making in the emergency care of geriatric fracture patients.