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Adv Emerg Nurs J. 2015 Oct-Dec;37(4):290-300. doi: 10.1097/TME.0000000000000080.

The Value of Continuous ST-Segment Monitoring in the Emergency Department.

Author information

1
Yale School of Nursing, West Haven, Connecticut (Drs Bovino, Funk, Jefferson, and Andrews); Yale School of Public Health, New Haven, Connecticut (Dr Desai); Emergency Department, Bridgeport Hospital, Bridgeport, Connecticut (Dr Bovino and Mr Forte); and University of California, San Francisco (UCSF) (Dr Pelter). Dr Bovino is now with the Quinnipiac University School of Nursing, Hamden, Connecticut.

Abstract

Practice standards for electrocardiographic monitoring recommend continuous ST-segment monitoring (C-STM) in patients presenting to the emergency department (ED) with signs and/or symptoms of acute coronary syndrome (ACS), but few studies have evaluated its use in the ED. We compared time to diagnosis and 30-day adverse events before and after implementation of C-STM. We also evaluated the diagnostic accuracy of C-STM in detecting ischemia and infarction. We prospectively studied 163 adults (preintervention: n = 78; intervention: n = 85) in a single ED and stratified them into low (n = 51), intermediate (n = 100), or high (n = 12) risk using History, ECG, Age, Risk factors, and Troponin (HEART) scores. The principal investigator monitored participants, activating C-STM on bedside monitors in the intervention phase. We used likelihood ratios (LRs) as the measure of diagnostic accuracy. Overall, 9% of participants were diagnosed with ACS. Median time to diagnosis did not differ before and after implementation of C-STM (5.55 vs. 5.98 hr; p = 0.43). In risk-stratified analyses, no significant pre-/postdifference in time to diagnosis was found in low-, intermediate-, or high-risk participants. There was no difference in the rate of 30-day adverse events before versus after C-STM implementation (11.5% vs. 10.6%; p = 0.85). The +LR and -LR of C-STM for ischemia were 24.0 (95% confidence interval [CI]: 1.4, 412.0) and 0.3 (95% CI: 0.02, 2.9), respectively, and for infarction were 13.7 (95% CI: 1.7, 112.3) and 0.7 (95% CI: 0.3, 1.5), respectively. Use of C-STM did not provide added diagnostic benefit for patients with signs and/or symptoms of myocardial ischemia in the ED.

PMID:
26509726
PMCID:
PMC4644066
DOI:
10.1097/TME.0000000000000080
[Indexed for MEDLINE]
Free PMC Article

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