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

Autor: Vanessa Jefferson, Leonie L Rose Bovino, Marjorie Funk, Michele M. Pelter, Laura Kierol Andrews, Kenneth Forte, Mayur M. Desai
Rok vydání: 2015
Předmět:
Male
Infarction
Emergency Nursing
Cardiovascular
Emergency Care
Electrocardiography
Risk Factors
80 and over
Prospective Studies
Prospective cohort study
continuous ST segment monitoring
Aged
80 and over
Emergency Service
screening and diagnosis
biology
medicine.diagnostic_test
emergency
Middle Aged
Health Services
Detection
Heart Disease
Emergency Medicine
Female
Emergency Service
Hospital
4.2 Evaluation of markers and technologies
Adult
medicine.medical_specialty
Acute coronary syndrome
Clinical Trials and Supportive Activities
Nursing
electrocardiogram
Risk Assessment
Sensitivity and Specificity
Article
acute coronary syndrome
Hospital
Clinical Research
Internal medicine
medicine
Humans
Acute Coronary Syndrome
Adverse effect
Heart Disease - Coronary Heart Disease
Aged
business.industry
ST-segment
Emergency department
medicine.disease
Atherosclerosis
Troponin
Confidence interval
United States
monitor
Emergency medicine
biology.protein
business
Zdroj: Advanced emergency nursing journal, vol 37, iss 4
Popis: 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.
Databáze: OpenAIRE
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