Hrev_master [page 80] [Emergency Care Journal 2025; 21:13937] Emergency Care Journal 2025 volume 21:13937 Abstract This study explores the epidemiology and sex-specific charac- teristics of geriatric patients presenting to 36 Emergency Departments (EDs) across 9 European countries (EGERS study). This sub-analysis investigates potential associations between sex disparities and various characteristics, including demographics, personal traits, clinical findings, and main clinical outcomes, both in the general study population and across different age groups (old: 65-74 years, older: 75-84 years, and oldest: 85 years and above). Overall, females were more represented than males (51.5% vs. 48.5%), and this difference increased with increasing age groups. Females were more likely to use home support services, were visited for traumatic causes, and had a history of falls. In con- trast, males had higher rates of hospitalization in ordinary wards (45.4% vs. 41.2%) and intensive care units (9.8% vs. 7.6%). In- hospital mortality was also higher in males (9.3%) compared to females (7.5%), and the difference increases with increasing age. In ED patients, the male-to-female ratio favoured women, particu- larly among those aged 85+ years. Males had more comorbidities, such as coronary artery disease, dyslipidaemia, active malignancy, prior stroke, chronic renal failure, history of coronary events, chronic liver disease, excessive smoking and alcohol abuse. Females had more traumatic events and falls. Hospitalisation and mortality rates were higher in males, especially in the older and oldest age groups. Introduction The elderly are increasingly faced with difficulties in accessing adequate and timely care. This entails the need for individuals with limited access to primary care or specialist services to visit the ED.1 The increase in elderly patients, who turn to EDs even for rea- sons not strictly linked to the emergency context, is creating more and more problems for healthcare organizations, leading to an overall increase in hospital admissions and longer stays, with a consequent rise in waiting times at the emergency room and over- crowding.2 The available data reveal a lack of knowledge and competence in the treatment and management of elderly subjects in the EDs: this results in an increased number of complications, functional decline, and unfavorable prognosi.3,4 Although awareness of frailty Correspondence: Andrea Fabbri, Emergency Department, Local Health Agency of Romagna, Forli, Italy. E-mail: andrea.fabbri@auslromagna.it Key words: sex specific characteristics, older subjects, risk profile, comorbidity, unfavorable outcomes. Contributions: Conception and design: AF, SL and MAK; acquisition of data: AS, EP, LPB, VNA, AP, AF and SL; analysis: DZD, AC and SL; interpretation of data: AC, AF, EP, LPB, VNA, AP, AS, MP and SL; drafting the article: AF and AP, MAK; revising the article critically for important intellectual content: AS, EP, LPB, VNA, MP and SL Final approval of the version to be published: AF, AS, MAK, EP, LPB, VNA, AP, AC, MP and SL The EUSEM research network study group includes all investigators that recruited patients in the current study. Details of the EUSEM research network study group are included in the Supplementary Materials. All authors have read and agreed to the published version of the manu- script. Conflicts of interest: the authors declare no support from any organization other than the funding agency listed below, no financial relationships with any organi- zations that might have an interest in the submitted work in the previous 3 years, and no other relationships or activities that could appear to have influenced. Funding: the study was performed under the supervision of the EUSEM Research network. Data management in Europe was provided by the European Society for Emergency Medicine (EUSEM), a European non-profit organization. This research received no other specific grant from any funding agency in the public or commercial sectors. Institutional review board statement: the study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of Montpellier University Hospital (IRB 202000417, date of approval 30 March 2020). Informed consent statement: not applicable. Data availability: the data presented in this study are available on request from the corresponding author. The data are not publicly available due to local legislation. Acknowledgements: the authors are grateful to European Research Network on the behalf of European Society for Emergency Medicine for helpful support. Received: 30 April 2025. Accepted: 11 July 2025. Early view: 27 August 2025. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2025 Licensee PAGEPress, Italy Emergency Care Journal 2025; 21:13937 doi:10.4081/ecj.2025.13937 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Sex disparities in older patients attending the european emergency departments: an EGERS sub-analysis Andrea Fabbri,1 Effie Polyzogopoulou,2 Defne Z. Dündar,3 Anna Slagman,4 Mehmet Ergin,5 Kelly Ann Catherine Janssens,6 Lars P. Bjornsen,7 Sándor Somodi,8 Nesek Adam Višnja,9,10 Hu ̈seyin A. Demir,11 Said Laribi,12 Mehmet A. Karamercan,13 on behalf of the EGERS research network study group* 1Emergency Department, Local Health Agency of Romagna, Forli, Italy; 2Emergency Department, University General Hospital Attikon, Athens, Greece; 3Department of Emergency Medicine, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey; 4Division of Emergency and Acute Medicine, Campus Virchow Klinikum and Charité Campus Mitte, Charite Universitatmedizin, Berlin, Germany; 5Department of Emergency Medicine, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey; 6Department of Emergency Medicine, St. Michael’s Hospital, Dublin, Ireland; 7Department of Circulation and Medical Imaging, Norwegian University, Trondheim, Norway; 8Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; 9Department of Anesthesiology, Resuscitation and Intensive Care, Clinical Hospital Sveti Duh, Zagreb, Croatia; 10Emergency Department, Clinical Hospital Sveti Duh, and University of North, Varaždin, Croatia; 11Department of Emergency Medicine, Sanliurfa Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey; 12Emergency Medicine Department, Tours University Hospital, Tours, France; 13Department of Emergency Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey syndromes is growing, translating this knowledge into daily clini- cal practice remains challenging.5 Sex differences due to biological factors, personal risk profiles, and diagnostic and therapeutic uncertainties pose additional chal- lenges for emergency physicians. In a recent study involving more than 5,000 patients over the age of 65 who visited 36 Emergency Departments (EDs) in 9 European countries (EGERS study), the epidemiological, clinical, and outcome characteristics of cases admitted to hospitals were examined.6 The present study presents a sub-analysis of the original data- base, aiming to explore in depth the associations between various patient characteristics and sex differences across different age sub- groups. Materials and Methods Study design, population The detailed design, methods, and main results of the EGERS study have been previously reported.6 In brief, the study included 36 EDs across 9 European nations, i.e. [France (n=8), Turkey (n=7), Ireland (n=6), Hungary (n=5), Germany (n=4), Italy (n=2), Croatia (n=2), Norway (n=1), and Greece (n=1)]. This chart review analysis included all consecutive patients aged 65 and older who attended the ED between October 19 and November 30, 2020 (7 consecutive days). The first published original study reported patient demographic, clinical, and laboratory data. The national ethics committees approved the protocol, and all participants pro- vided written informed consent for trial participation.6 The original study protocol excluded subjects transferred from other hospitals, those presenting to the ED with ongoing cardiopul- monary resuscitation, individuals with a ‘do not resuscitate’ order, those unwilling to participate, and those revisiting the ED during the study period. Data collection included demographics, day of the week, time of admission (classified into three time slots: 08:00-16:00; 16:01- 23:59; 00:00-08:00), major presenting complaints, initial vital signs upon presentation, main comorbidities, current medications, home support services, a history of falls within the last 6-months, and clinical findings at arrival in ED. Major presenting complaints were categorized as traumatic, nontraumatic, or both. The following comorbidities were consid- ered: Hypertension (HTN), Diabetes Mellitus (DM), history of Coronary Artery Disease (CAD), dyslipidemia, active malignancy, Chronic Obstructive Pulmonary Disease (COPD)/asthma, history of stroke, dementia/Alzheimer disease, Chronic Renal Failure (CRF), Left Ventricular Failure (LVF), prior percutaneous Coronary Intervention (PCI)/Coronary Artery Bypass Grafting (CAGB), Chronic Liver Disease (CLD), smoking (defined as active smoking or having stopped smoking within the last year), and history of alcohol abuse (defined as >30g/day for males and >20g/day for females). Upon arrival, the following vital signs were considered: Systolic Blood Pressure (SBP) <100 mmHg, SBP >140 mmHg, Diastolic Blood Pressure (DBP) >90 mmHg, mean arterial pres- sure (MAP) >90 mmHg, pulse rate <60 beats/min, Pulse Rate (PR) >100 beats/min, Respiratory Rate (RR) >25 breaths/min., temper- ature >38 °C, Oxygen saturation (Sat O2) <90% additional O2 sup- port, and Glasgow Coma Scale <15. Upon presentation, the Modified Early Warning Score (MEWS),7 the Rapid Emergency Medicine Score (REMS), and the National Early Warning Score (NEWS)8 were also calculated. The primary outcome measures included the epidemiological characteristics and sex differences of elderly subjects presenting in Emergency Departments (EDs) across Europe, as well as the rates of hospitalization, intensive care unit admissions, and in-hospital mortality. All analyses were conducted in three different age groups: the old (65-74), the older (75-84), and the oldest (≥85). Statistical analysis Patients were classified based on their age. Normality analyses of the data were performed using the Kolmogorov–Smirnov and Shapiro–Wilk tests. The normally distributed quantitative vari- ables were expressed as the mean ± SD, while non-normally dis- tributed quantitative variables were expressed as the median (25th percentile–75th percentile, interquartile range – IQR). The categor- ical variables were expressed as frequencies (percentages). The one-way ANOVA and Kruskal–Wallis tests were used to assess the inter-group differences in quantitative variables. The inter-group differences between categorical variables were evalu- ated using the Chi-square and Fisher’s Exact tests as appropriate. To remove variables, we used multivariable logistic regression with forward stepwise selection, setting the P value threshold at 0.05. The Odds Ratio (OR) and 95% confidence intervals (95% CI) were also calculated. Two-tailed P values <0.05 were considered statistically significant. Statistical analyses were conducted using the Statistical Package for the Social Sciences SPSS/PC+, 20.0 edition). Cases with missing data for a variable were excluded from analyses pertaining to that variable but included in other analyses. Results The analysis of the original database of the EGERS study (5,765 patients) indicated that females were more represented (51.4%) than males (48.5%); this difference progressively increased with age (Table 1). The distribution of the encounters by day of the week ranged from 16.8% (15.9-17.8%) (95% CI) on Monday to 11.0% (10.2-11.9%) (95% CI) on Sunday, without dif- ferences between males and females. Arrival time by time slot did not differed between males and females and was 53.7% (52.4-55.0%); (95% CI) from 08:00 to 16:00, 35.5% (34.3-36.7%) (95% CI) from 16:00 to midnight and 10.7% (10.0-11.6%) (95% CI) from 00:00 to 08:00. Traumatic causes of presentation were more common in females (18.4%) compared to males (13.3%), and this difference increased proportionally with age (Table 1). Likewise, a history of falls was also more frequent in females (30.8%) in contrast to males (23.4%), as well as the availability of a home help service (28.7%) vs. (22.3%) (Table 1). Main comorbidities, such as CAD, dyslipidemia, active malig- nancy, previous stroke, CRF, history of coronary events, CLD, excessive smoking, and alcohol abuse, were more frequent in males. At the same time, HTN and dementia were more common in females (Figure 1). Chronic medications were reported in 85.7% (84.8%-86.6%) (95% CI) of cases. One or two medications were taken by 26.2%, (27.3%-25.0%) (95% CI) of subjects, three to four medications in 36.0% (34.8-37.3%) (95% CI), while five or more medications in 9.6%, (8.8%-10.4%) (95% CI) of subjects. Vital signs upon presentation in the ED are shown in Table 2. An SBP >140 mmHg was more frequently registered in females, while an RR >25 breaths/min and a body temperature >38 °C in Article [Emergency Care Journal 2025; 21:13937] [page 81] males (Table 2) were more prevalent in males. Main discharge or admission diagnoses, classified by ICD-10 coding categories, are reported in Table 3. Diagnoses of trauma, poisoning, and other consequences of external causes (S00-S88), those indicative of mental, behavioral, and neurodevelopmental disorders (F01-F99) were most commonly reported in females, in contrast diseases of the respiratory system (J00-J99) and genitouri- nary system (N00-N99) were most frequently reported in males (Table 3) The Length of Stay (LoS) in the ED was 5 (3.0-8.0) hours (median [IQR]) without differences between males and females, while the time spent in the observation units did not differ (5.2 hours in males vs. 6.0 hours in females) (Figure 2). A total of 62 of 5,765 cases, 1.1% (0.8-1.4) (95% CI), died during ED stay, but no differences were found in relation to sex category or age group. The hospitalization rate both in the ordinary ward and in inten- sive care unit was higher in men than in women (Figure 2), as was the length of hospital stay: males 5 days; (1.0-11.0), (95% CI) vs women 4 days (1.0-10.0),( 95% CI, P<0.001). In-hospital mortality was higher in men 9.3% (8.2%-10.4%) vs. 7.5% (6.5%-8.5%) (95% CI, P=0.017) (Figure 3). This differ- ence between males and females increased with age (Figure 3). In the logistic analysis, the variables entered the model for mortality were age in the older age categories, i.e. age 75-84 years (OR 1.64, 1.19-2.26) (95% CI; P=0.002), ≥ 85 years (OR 2.27; 1.61-3.22) (95% CI; P<0.001), trauma causes (OR 0.29, 0.14-0.60) (95% CI; P<0.001), an advanced NEWS level at arrival (OR 1.30, 1.25-1.35) (95% CI; P < 0.001), the presence of home support service (OR 1.40, 1.06-1.89) (95% CI; P=0.019), the need for intensive care (OR 0.60, 4.50-8.05) (95% CI; P<0.001). However, sex category was not included among the variables selected by the model. Discussion This sub-analysis of the EGERS study reveals that females, particularly in the older age groups, more frequently visited the ED due to traumatic causes and had a higher likelihood of requiring home support services and having a history of falls. In contrast, males had a higher burden of comorbidities, including CAD, dys- lipidemia, active malignancy, previous stroke, CRF, history of coronary events, CLD, excessive smoking, and alcohol abuse. Males were more frequently hospitalized, both in ordinary wards and ICUs, and had a higher in-hospital mortality rate, especially in the oldest age groups. Our findings confirm recent studies that report increased mor- Article Figure 1. Main comorbidities of patients in relation to age or sex disparities. Data reported as number of cases and percent with 95% confidence intervals (95% CI). P<0.05 for significance. Table 1. Patients’ characteristics in relation to major complaint, home help service and history of falls in relation to sex categories and age groups: old (65-74 years), older (75-84 years), oldest (≥84 years). Data reported as number of cases, percent with 95% confidence intervals (95% CI). Males Females N cases % (95% CI) N cases % (95% CI) P Age groups All Cases 2796 48.5 (47.2-49.8) 2967 51.4 (50.2-52.7) Old 1185 42.4 (40.5-44.2) 1077 36.3 (34.6-38.0) <0.001 Older 1052 37.6 (35.8-39.4) 1039 35.0 (33.3-36.7) Oldest 561 20.0 (18.6-21.5) 85 1 28.7 (27.1- 30.3) Traumatic Major Complaint All cases 338 13.3 (11.9-14.6) 508 18.4 (17.0-19.9) <0.001 Old 136 12.5 (10.5-14.4) 143 14.0 (11.9-16.1) 0.304 Older 116 12.3 (10.2-14.4) 167 17.5 (15.0-19.9) 0.002 Oldest 86 16.8 (13.6-20.0) 198 25.4 (22.3-28.4) <0.001 Home Help Service All cases 537 22.3 (20.6-23.9) 742 28.7 (27.0-30.4) <0.001 Old 134 12.9 (10.9-14.9) 117 12.2 (10.2-14.3) 0.619 Older 210 23.8 (21.0-26.6) 240 27.0 (24.1-29.9) 0.182 Oldest 193 39.5 (35.1-43.8) 385 52.0 (48.4-55.6) <0.001 History of falls All cases 352 14.7 (13.2-16.1) 470 18.3 (16.8-19.8) 0.002 Old 97 9.4 (7.6-4.8) 98 10.4 (8.4-12.3) 0.670 Older 141 16.0 (13.6-18.4) 146 16.5 (14.1-19.0) 0.705 Oldest 114 23.4 (19.6-27.1) 226 30.8 (27.5-34.2) 0.015 [page 82] [Emergency Care Journal 2025; 21:13937] Article Table 2. Clinical findings at ED arrival in relation to sex differences and age categories: old (65-74 years), older (75-84 years) oldest (≥ 84 years). Data reported as number of cases, percent with 95% confidence intervals (95% CI). Males Females N = 2798 % (95% CI) N=2967 % (95% CI) P SBP <100 mmHg 140 5.2 (4.4-6.1) 133 4.7 (3.9-5.5) 0.364 SBP >140 mmHg 1216 45.3 (43.5-47.2) 1431 50.5 (48.6-52.3) <0.001 DBP >90 mmHg 629 23.5 (21.9-25.1) 647 22.8 (21.3-24.4) 0.573 MAP <65 mmHg 62 2.3 (1.7-2.9) 75 2.6 (2.1-3.2) 0.435 Pulse <60 beats/min 197 7.4 (6.4-8.4) 113 4.0 (3.3-4.7) 0.001 Pulse >100 beats/min 405 15.2 (13.9-16.6) 446 15.8 (14.5-17.2) 0.562 RR >25 breaths/min 205 9.6 (8.3-10.8) 166 7.5 (6.4-8.6) 0.014 Temperature <36°C 83 3.1 (2.4-3.8) 71 2.5 (1.9-3.1) 0.186 Temperature >38°C 70 2.6 (2.0-3.2) 37 1.3 (0.9-1.7) <0.001 Sat O2 <90% 187 7.1 (6.1-8.1) 182 6.5 (5.6-7.4) 0.365 O2 support 404 16.7 (15.2-18.1) 394 14.9 (13.6-16.3) 0.096 GCS <15 277 9.9 (8.8-11.0) 362 12.2 (11.1-13.4) 0.011 Table 3. Most represented main ICD10 diagnosis code of patients in relation to sex categories. Data reported as number of cases and per- cent with 95% confidence intervals (95% CI). Males (N=2798) Females (N= 967) ICD 10 Code groups N cases % (95% CI) N cases % (95% CI) P Diseases of the circulatory system (I00-I99) 398 14.7 (13.4-16.0) 447 15.4 (14.1-16.7) 0.371 Injury, poisoning and certain other consequences of external causes (S00-T88) 384 14.2 (12.9-15.5) 519 17.9 (16.5-19.3) <0.001 Certain infectious and parasitic diseases (A00-B99) 359 13.3 (12.0-14.5) 324 11.2 (10.0-12.3) 0.024 Diseases of the respiratory system (J00-J99) 278 10.3 (9.1-11.4) 218 7.5 (6.6-8.5) <0.001 Diseases of the digestive system (K00-K95) 267 9.9 (8.7-11.0) 305 10.5 (9.4- 11.6) 0.355 Diseases of the nervous system (G00-G99) 215 7.9 (6.9-9.0) 249 8.6 (7.6-9.6) 0.333 Diseases of the genitourinary system (N00-N99) 207 7.6 (6.6-8.6) 148 5.1 (4.3-5.9) <0.001 Symptoms. signs and abnormal clinical and laboratory findings (R00-R99) 166 6.1 (5.2-7.0) 149 5.1 (4.3-5.9) 0.132 Diseases of the musculoskeletal system and connective tissue (M00-M99) 106 3.9 (3.2-4.6) 150 5.2 (4.4-6.0) 0.019 Diseases of the skin and subcutaneous tissue (L00-L99) 72 2.7 (2.1-3.3) 74 2.5 (2.0-3.1) 0.037 Diseases of the blood and blood-forming organs (D50-D89) 63 2.3 (1.8-2.9) 47 1.6 (1.2-2.1) 0.064 Endocrine. nutritional and metabolic diseases (E00-E89) 60 2.2 (1.7 - 2.8) 87 3.0 (2.4-3.6) 0.058 Neoplasms (C00-D49) 42 1.6 (1.1-2.0) 25 0.9 (0.5-1.2) 0.020 Mental. behavioural and neurodevelopmental disorders (F01-F99) 27 1.0 (0.6-1.4) 64 2.2 (1.7-2.7) <0.001 Diseases of the eye and adnexa (H00-H59) 24 0.9 (0.5-1.2) 43 1.5 (1.0-1.9) 0.039 Diseases of the ear and mastoid process (H60-H95) 23 0.8 (0.5-1.2) 25 0.9 (0.5-1.2) 0.796 Factors influencing health status and contact with health services (Z00-Z99) 17 0.6 (0.3-0.9) 28 1.0 (0.6-1.3) 0.147 Figure 3. In hospital mortality of subjects visited in the ED, in relation to sex category in each age groups: old (65-74 years), older (75-84 years) oldest (≥84 years). Data reported as number of cases and percent with 95% confidence intervals (95% CI).P<0.05 for significance. Figure 2. Main outcome measures of old patients in relation to sex categories. Data reported as number of cases and percent with 95% confidence intervals (95% CI). P<0.05 for significance. [Emergency Care Journal 2025; 21:13937] [page 83] tality in males, even after adjusting for disease severity. This increased risk is consistent across triage priorities and main pre- senting complaints, such as chest pain, suspected infection, and trauma, particularly in older age groups.9 The percentage of females attending the ED increased in rela- tion to age groups, as did the rate of transport through the emer- gency medical system, hospitalization rate, and mortality.10 This difference was also confirmed in some case series of individuals hospitalized for specific diagnoses like sepsis, where females had lower hospitalization rates and 30-day mortality compared to males, as well as a lower comorbidity profile, disease severity, and incidence of complications such as thrombocytopenia and fever, but a higher incidence of urinary tract infection.11 In our prognostic model, although mortality was higher in males, sex was not considered as an independent predictive vari- able. The lack of significance could be attributed to the sample size, as the relevant difference in comorbidities and clinical pre- sentations in males may have influenced the results. A multidimen- sional approach that includes a validated frailty assessment could potentially improve the predictive accuracy of such models.12 In a recent study of a group of elderly patients visiting the ED for sus- pected sepsis, women showed fewer comorbidities, particularly chronic lung disease, chronic kidney disease, coronary artery dis- ease, and diabetes. Also in this case, despite the lower severity of the disease, sex was not among the variables selected by the logis- tic model for 30-day mortality.11 Our results confirm that elderly males presenting to the ED have more comorbidities than females; however, neither sex nor the comorbidity index was selected as an independent variable associated with mortality in the logistic model. A larger number of cases with more homogeneous disease severity could likely reveal sex differences. Polypharmacy was indicated as an indirect indica- tor of a severity profile associated with increased 3-month mortal- ity.13 Although the association observed between polytherapy and mortality is complex, due to the confounding effect of comorbidity and frailty,13 a positive association between polytherapy and adverse events has been proven.14,15 In our series, the association between the number of drugs taken in relation to increasing age is confirmed, but no difference between males and females was observed, and no association in the predictive model on mortality was found. Although we did not use a clinical frailty scale, we provided an indirect measure of frailty, such as the need for home support serv- ices, the number of falls in the previous six months, and the num- ber of daily medications. The lower availability of home support services in males could be viewed as a negative prognostic indica- tor. A multidimensional evaluation performed at the initial approach in the ED, using a simplified score, could support the emergency physician in clinical decisions and in predicting a patient’s outcome. In a recent study, the use of the Brief MPI16 proved to be a useful predictor of frailty, demonstrating excellent discriminating capacity comparable to that of other scores widely validated in clinical practice, regardless of the patient’s age or sex. Such a clinical approach, even in the emergency area, could improve the quality of care.17 In this context, an expert task force of physicians has produced clinical guidelines for geriatric emer- gency medicine to promote their application in current clinical practice.18 Given that elderly patients make up a significant portion of ED visits and require substantial resources, the findings of our study could help raise awareness during the initial assessment of these patients upon ED arrival. Limitations Several limitations should be acknowledged. First, our results should not be considered reliable for describ- ing the state of European emergency departments, as the recruit- ment period for cases was limited to only one week. Furthermore, it should not be forgotten that the cases were recruited during the COVID-19 pandemic, representing a different case mix than today. Finally, all the cases studied came from only 9 European countries. More extensive data collection, involving a larger number of coun- tries, may address the weaknesses of our study. Second, variations in access to EDs and observation units across different countries, due to differences in healthcare systems and administrative practices, could have influenced the results. Moreover, not all centers had specialist geriatric units, potentially leading to differences in admission criteria. Third, while the study provided indirect measures of frailty, it did not consider a multidimensional evaluation of patients, which could have affected hospitalization criteria, complication rates, and mortality. Lastly, although hospitalization decisions were based on the judgment of individual physicians, varying organizational struc- tures in different countries might have introduced inconsistencies in admission decisions. Despite these limitations, we believe that this observational study may expand the knowledge of the epidemiology of patients accessing the EDs across Europe. The diversity in practices and patient profiles, even within the same country or city, is a key fea- ture of this study, rather than a limitation. Conclusions This sub-analysis of the EGERS study describes the character- istics of elderly subjects accessing the ED highlighting gender dif- ferences. Women were the majority, particularly in the older age group, while men had a higher prevalence of severe age-associated comorbidities. In contrast, traumatic events and falls were more common in women. Hospital admissions and mortality were higher in males, particularly in older age groups. References 1. van Oppen JD, Keillor L, Mitchell Á, et al. What older people want from emergency care: a systematic review. Emerg Med J 2019;36:754-761. 2. Magidson PD, Carpenter CR. Trends in geriatric emergency medicine. 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Smith GB, Prytherch DR, Meredith P, et al. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation 2013;84:465-70. 9. Candel BG, Dap S, Raven W, et al. Sex differences in clinical presentation and risk stratification in the Emergency Department: An observational multicenter cohort study. Eur J Intern Med 2022;95:74-9. 10. Lee SB, Oh JH, Park JH, et al. Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department. Clin Exp Emerg Med 2018;5:249-55. 11. Wanrooij VHM, Cobussen M, Stoffers J, et al. Sex differences in clinical presentation and mortality in emergency department patients with sepsis. Ann Med 2023;55:2244873. 12. Kabell Nissen S, Rueegg M, Carpenter CR, et al. Prognosis for older people at presentation to emergency department based on frailty and aggregated vital signs. 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