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


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.
Durairaj
L
L
Department of Medicine, Cook County Hospital and Rush Medical College, Chicago, Illinois 60612, USA.
Reilly
B
B
Das
K
K
Smith
C
C
Acob
C
C
Husain
S
S
Saquib
M
M
Ganschow
P
P
Evans
A
A
McNutt
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000175:diagnosis; D015716:Electrocardiography, Ambulatory / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000175:diagnosis; D006801:Humans; D007022:Hypotension / Q000175:diagnosis; D007087:Illinois; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D010343:Patient Admission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D013686:Telemetry / Q000706:statistics & numerical data*