title: Physician documentation of nonspecific EKG changes predicts hospital admission among observation unit chest pain patients.
abstract: Our emergency department (ED) observation unit specifically excludes patients with "significant" electrocardiogram (EKG) findings, but patients may be admitted with "nonspecific" EKG findings. We evaluated whether physician documentation of nonspecific findings predicted eventual admission to an inpatient unit from the observation unit. We reviewed the charts of all chest pain patients admitted to our ED observation unit over a 14-month period. We recorded patients as having documented nonspecific EKG findings if the ED physician stated in the chart that the patient had nonspecific ST segment, T-wave, or Q-wave findings. We recorded baseline characteristics and admission rates among patients. Results were analyzed with chi2 statistics. Five hundred thirty-one chest pain patients were admitted to the observation unit during the study period, and 79 patients (14.9%) had documented nonspecific EKG findings. Patients (22.8%) with documented nonspecific EKG findings were admitted to an inpatient unit from the observation unit, compared with 14.2% of patients without documented nonspecific EKG findings (P = 0.041). Patients with documented nonspecific EKG changes also had higher rates of positive stress testing (17.5% vs. 10.5%, P = 0.103) and stent placement (5.1% vs. 3.3%, P = 0.309), although these were not statistically significant. Patients with documented nonspecific EKG findings were admitted to an inpatient unit from the observation unit at higher rates than those without these findings. Physicians may wish to use the ED EKG more effectively in screening patients for admission to the ED observation unit.
authors.affiliation: School of Medicine, University of Utah, Salt Lake City, Utah 84132, USA. troy.madsen@hsc.utah.edu
authors.forename: Troy
authors.initials: T
authors.lastname: Madsen
authors.forename: Joseph
authors.initials: J
authors.lastname: Bledsoe
authors.forename: Philip
authors.initials: P
authors.lastname: Bossart
mesh_terms: D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D002637:Chest Pain / Q000175:diagnosis* / Q000628:therapy; D015331:Cohort Studies; D004282:Documentation; D004562:Electrocardiography / Q000379:methods*; D004635:Emergency Medicine / Q000379:methods; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006757:Hospital Units; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015999:Multivariate Analysis; D019370:Observation / Q000379:methods*; D010343:Patient Admission / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity