Emergency department admissions to inpatient cardiac telemetry beds: a prospective cohort study of risk stratification and outcomes

• Published in: The American journal of medicine Vol. 110; no. 1; pp. 7 - 11
• Main Authors: Durairaj, Lakshmi, Reilly, Brendan, Das, Krishna, Smith, Christopher, Acob, Christine, Husain, Shahid, Saquib, Mohammed, Ganschow, Pamela, Evans, Arthur, McNutt, Robert
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2001; Elsevier; Elsevier Sequoia S.A
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analysis. Health state; Angina, Unstable - diagnosis; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Coronary heart disease; Electrocardiography, Ambulatory - statistics & numerical data; Emergency Service, Hospital; Emergency services; Epidemiology; Female; General aspects; Health risk assessment; Heart; Heart Failure - diagnosis; Humans; Hypotension - diagnosis; Illinois; Male; Medical equipment; Medical sciences; Middle Aged; Myocardial Infarction - diagnosis; Patient Admission - statistics & numerical data; Predictive Value of Tests; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk; Risk Factors; Telemetry - statistics & numerical data; Human; Bed; Prognosis; Infarct; Hospital admission; Cardiovascular disease; Telemetry; Coronary heart disease; Myocardial disease; Prospective; Emergency department; Cohort study; Myocardium; Monitoring; Public health
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/S0002-9343(00)00640-9

Purpose: Little is known about physicians’ use of inpatient cardiac telemetry units among emergency department patients at risk for cardiac complications. We therefore studied the outcomes of patients admitted to inpatient telemetry beds to identify a subset of patients from whom cardiac monitoring could be withheld safely. Subjects and Methods: We conducted a prospective cohort study of 1,033 consecutive adult patients admitted to an inpatient telemetry unit from the emergency department of a 700-bed urban public teaching hospital. Subjects with or without chest pain were risk-stratified using a prediction rule and observed for in-hospital cardiac complications, acute myocardial infarction, and transfer to an intensive care unit (ICU). Results: There were no significant differences between patients with (n = 677) or patients without chest pain (n = 356) in the rates of major cardiac complications, myocardial infarctions, or transfers to an ICU. Among 318 patients with chest pain who were classified as being very low risk, none suffered major complications (negative predictive value 100%; 95% confidence interval [CI]: 98.8% to 100%). Among 214 very low risk patients without chest pain, 1 (0.5%) had a major complication (negative predictive value 99.5%; 95% CI: 97.4% to 99.9%). Conclusions: The prediction rule accurately identified patients with or without chest pain who were at very low risk of major complications, identifying a subset from whom cardiac monitoring could be withheld safely.