Lack of utility of telemetry monitoring for identification of cardiac death and life-threatening ventricular dysrhythmias in low-risk patients with chest pain.
OBJECTIVE
Low-risk patients with chest pain are often admitted to monitored beds; however, the use of telemetry beds in this cohort is not evidence based. We tested the hypothesis that monitoring admitted low-risk patients with chest pain for dysrhythmia is low yield (<1% detection of life-threatening dysrhythmias requiring treatment).


METHODS
We conducted a prospective cohort study of emergency department (ED) patients with chest pain with a Goldman risk score of less than 8%, a normal initial creatine kinase-MB level, and a negative initial troponin I level admitted to non-ICU monitored beds. Investigators followed the hospital course daily. The main outcome was cardiovascular death and life-threatening ventricular dysrhythmia during telemetry.


RESULTS
Of 3,681 patients with chest pain who presented to the ED, 1,750 patients were admitted to non-ICU monitored beds. Of these, 1,029 patients had a Goldman risk score of less than 8%, a troponin I level of less than 0.3 ng/mL, and a creatine kinase-MB level of less than 5 ng/mL (accounting for 59% of all chest pain telemetry admissions). During hospitalization, there were no patients with sustained ventricular tachycardia/ventricular fibrillation requiring treatment on the telemetry service (0%; 95% confidence interval [CI] 0% to 0.3%). There were 2 deaths: neither was cardiovascular in nature or preventable by monitoring (cardiovascular preventable death rate=0%; 95% CI 0.0% to 0.3%).


CONCLUSIONS
The routine use of telemetry monitoring for low-risk patients with chest pain is of limited utility. Admission to nonmonitored beds might help alleviate ED crowding without increasing risk of adverse events caused by dysrhythmia in patients with a Goldman risk of less than 8%, an initial troponin I level of less than 0.3 ng/mL, and a creatine kinase-MB level of less than 5 ng/mL.
Hollander
Judd E
JE
Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104-4283, USA. jholland@mail.med.upenn.edu
Sites
Frank D
FD
Pollack
Charles V
CV
Shofer
Frances S
FS
D001145:Arrhythmias, Cardiac / Q000097:blood / Q000175:diagnosis*; D001513:Beds; D002423:Cause of Death; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis*; D015331:Cohort Studies; D003327:Coronary Disease / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D003643:Death; D004636:Emergency Service, Hospital; D005080:Exercise Test; D005260:Female; D006760:Hospitalization; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013686:Telemetry / Q000706:statistics & numerical data*; D019210:Troponin I / Q000097:blood; D018754:Ventricular Dysfunction / Q000097:blood / Q000175:diagnosis*
D007527:Isoenzymes; D019210:Troponin I; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form