A Model for Developing Subspecialty Clinical Practice Guidelines: The Geriatric Emergency Department Guidelines 2.0

Satheesh Gunaga^{1

2

3}, Christopher R Carpenter⁴, Maura Kennedy^{5

6}, Lauren T Southerland⁷, Alexander X Lo⁸, Sangil Lee⁹, Kirby Swan^{1

3}, Fabrice Mowbray¹⁰, Rachel M Skains¹¹, Teresita M Hogan¹², Martin F Casey¹³, Kei Ouchi^{6

14}, Naomi R George¹⁵, Kerstin de Wit¹⁶, Cameron J Gettel^{17

18}, Katherine Selman¹⁹, Luna C Ragsdale^{20

21}, Anita N Chary²², James D van Oppen²³, Glenn Arendts²⁴, Charles L Maddow²⁵, Katherine M Hunold⁷, Katren R Tyler²⁶, Danya Khoujah²⁷, Ula Hwang^{17

28

29}, Shan Liu^{5

6}

Affiliations

¹ Department of Emergency Medicine, Henry Ford Health, Wyandotte Hospital, Wyandotte, Michigan, USA.
² Envision Healthcare, Ann Arbor, Michigan, USA.
³ Department of Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA.
⁴ Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁵ Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁶ Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.
⁷ Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA.
⁸ Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁹ Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
¹⁰ College of Nursing & College of Human Medicine, Michigan State University, East Lansing, Michigan, USA.
¹¹ Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Geriatric Research, Education and Clinical Center, Birmingham VAMC, Birmingham, Alabama, USA.
¹² Section of Emergency Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
¹³ Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
¹⁴ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
¹⁵ Department of Emergency Medicine, Division of Critical Care, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
¹⁶ Department of Emergency Medicine, Queens University, Kingston, Ontario, Canada.
¹⁷ Department of Emergency Medicine, Yale University, New Haven, Connecticut, USA.
¹⁸ Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, USA.
¹⁹ Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, USA.
²⁰ Department of Emergency Medicine, Durham VA Health Care System, Durham, North Carolina, USA.
²¹ Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
²² Department of Emergency Medicine, Medicine-Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA.
²³ Centre for Urgent and Emergency Care Research, University of Sheffield, Sheffield, United Kingdom.
²⁴ University of Western Australia Medical School, Crawley, Western Australia, Australia.
²⁵ Department of Emergency Medicine, University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA.
²⁶ Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California, USA.
²⁷ Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
²⁸ Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, New York, USA.
²⁹ Department of Emergency Medicine and Population Health, NYU Grossman School of Medicine, New York, USA.

PMID: 41019914
PMCID: PMC12476112
DOI: 10.1016/j.acepjo.2025.100247

A Model for Developing Subspecialty Clinical Practice Guidelines: The Geriatric Emergency Department Guidelines 2.0

Satheesh Gunaga et al. J Am Coll Emerg Physicians Open. 2025.

. 2025 Sep 16;6(6):100247.

doi: 10.1016/j.acepjo.2025.100247. eCollection 2025 Dec.

Authors

Affiliations

¹ Department of Emergency Medicine, Henry Ford Health, Wyandotte Hospital, Wyandotte, Michigan, USA.
² Envision Healthcare, Ann Arbor, Michigan, USA.
³ Department of Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA.
⁴ Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁵ Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁶ Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.
⁷ Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA.
⁸ Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁹ Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
¹⁰ College of Nursing & College of Human Medicine, Michigan State University, East Lansing, Michigan, USA.
¹¹ Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Geriatric Research, Education and Clinical Center, Birmingham VAMC, Birmingham, Alabama, USA.
¹² Section of Emergency Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
¹³ Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
¹⁴ Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
¹⁵ Department of Emergency Medicine, Division of Critical Care, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
¹⁶ Department of Emergency Medicine, Queens University, Kingston, Ontario, Canada.
¹⁷ Department of Emergency Medicine, Yale University, New Haven, Connecticut, USA.
¹⁸ Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, USA.
¹⁹ Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, USA.
²⁰ Department of Emergency Medicine, Durham VA Health Care System, Durham, North Carolina, USA.
²¹ Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
²² Department of Emergency Medicine, Medicine-Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA.
²³ Centre for Urgent and Emergency Care Research, University of Sheffield, Sheffield, United Kingdom.
²⁴ University of Western Australia Medical School, Crawley, Western Australia, Australia.
²⁵ Department of Emergency Medicine, University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA.
²⁶ Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California, USA.
²⁷ Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
²⁸ Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, New York, USA.
²⁹ Department of Emergency Medicine and Population Health, NYU Grossman School of Medicine, New York, USA.

PMID: 41019914
PMCID: PMC12476112
DOI: 10.1016/j.acepjo.2025.100247

Abstract

The original consensus-based Geriatric Emergency Department (GED) Guidelines, published in 2014, established a framework of core principles for delivering high-quality, age-appropriate emergency care for older adults. In response to significant advances in geriatric emergency medicine research and evolving clinical priorities, we developed the GED Guidelines 2.0 to ensure continued relevance, clinical utility, and evidence-based rigor. This concept paper describes the systematic and iterative process undertaken to update the guidelines, including the formation of multidisciplinary working groups and the application of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Unlike the original GED Guidelines, our approach prioritized methodological transparency, formalized evidence grading, and consensus building grounded in systematic reviews and meta-analyses. We describe the identification, recruitment, and collaboration of multidisciplinary clinical and academic experts working together to improve the care of older adults in the emergency department. Through this multidisciplinary effort, key geriatric domains were selected, priority topics identified, and systematic reviews and meta-analyses conducted to generate a robust evidence base for future guideline and policy development. The GED Guidelines 2.0 represents the first emergency medicine (EM) subspecialty guideline effort to fully adopt the GRADE framework, offering a novel blueprint for future EM guideline development.

Keywords: aged; emergency medicine; evidence-based medicine; geriatrics; health services for the aged; practice guidelines as topic; program development.

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Conflict of interest statement

Satheesh Gunaga is a volunteer board member for Compassion and Choices, a non-profit organization. Satheesh Gunaga recieved funding as a site Sub-Investigator on an NIH-funded study (NIH Prime Award No. 1U19AG078105-01A1) during the conduct of this initiative. Christopher R. Carpenter was awarded grants from the National Institute on Aging (NIA) through R33AG058926 and R61AG069822, the John A. Hartford Foundation, and the West Health Institute. Christopher R. Carpenter held leadership positions with the Geriatric Emergency Care Applied Research (GEAR) Network, the Clinician-Scientists in Transdisciplinary Aging Research (Clin-STAR) Coordinating Center, and the ACEP Geriatric Emergency Department Accreditation Advisory. Maura Kennedy received funding from the American College of Emergency Physicians and Gillian Reny Stepping Strong for Trauma Innovation, Brigham Health. Lauren T. Southerland was awarded grant from the NIA through K23AG061284. Rachel M. Skains was awarded grants from the NIA (R33AG058926) and the West Health Institute. Cameron J. Gettel was the pepper scholar with support from the Claude D. Pepper Older Americans Independence Center at Yale School of Medicine (P30AG021342) and the NIA (R03AG073988). Ula Hwang was awarded grants from the NIA (R33AG058926, R33AG069822), the John A. Hartford Foundation, and the West Health Institute. Shan Liu was awarded grants from Gillian Reny Stepping Strong for Trauma Innovation, Brigham Health; the John A. Hartford Foundation; and the West Health Institute.

Figures

**Figure 1**
Timeline of key milestones in geriatric emergency medicine, highlighting significant advancements related to the Geriatric Emergency Department Guidelines. ACEP, American College of Emergency Physicians; CPG, clinical practice guideline; GEAR, Geriatric Emergency Care Applied Research; GED, geriatric emergency department; GEM, geriatric emergency medicine; SAEM, Society for Academic Emergency Medicine.

**Figure 2**
A roadmap for developing the Geriatric Emergency Department Guidelines 2.0.

**Figure 3**
Geriatric Emergency Department Guidelines 2.0: Visual summary of input & impact. ED, emergency department; GRADE, Grading of Recommendations Assessment, Development, and Evaluation; GEM, geriatric emergency medicine.

**Figure 4**
Overview of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. PICO, Population, Intervention, Comparator, and Outcomes.

See this image and copyright information in PMC

References

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A Model for Developing Subspecialty Clinical Practice Guidelines: The Geriatric Emergency Department Guidelines 2.0

Affiliations

A Model for Developing Subspecialty Clinical Practice Guidelines: The Geriatric Emergency Department Guidelines 2.0

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources