PMID- 16338512
OWN - NLM
STAT- MEDLINE
DCOM- 20060228
LR  - 20071115
IS  - 0735-6757 (Print)
IS  - 0735-6757 (Linking)
VI  - 24
IP  - 1
DP  - 2006 Jan
TI  - ALARMED: adverse events in low-risk patients with chest pain receiving continuous 
      electrocardiographic monitoring in the emergency department. A pilot study.
PG  - 62-7
AB  - OBJECTIVES: Current guidelines suggest that most patients who present to an 
      emergency department (ED) with chest pain should be placed on a continuous 
      electrocardiographic monitoring (CEM) device. We evaluated the utility of CEM in 
      ED patients with chest pain. METHODS: We enrolled stable patients who presented 
      to a single ED with chest pain suspected to be ischemic in origin and who were 
      placed on CEM. Patients were classified according to risk of poor outcome using 3 
      published stratification tools. Trained observers prospectively recorded number 
      of monitored hours, alarms, changes in management, and monitor-detected adverse 
      events (AEs). The primary outcome measure was the rate of AEs detected by CEM. 
      Secondary outcome measures were the rate of alarms that resulted in a change in 
      management and number of false alarms. RESULTS: We enrolled 72 patients, 56% of 
      whom were categorized as very low-risk by Goldman risk criteria. During 371 
      monitored hours, we recorded 1762 alarms or 4.7 alarms per monitored hour. There 
      were 11 AEs (0.68%; 95% CI, 0.35%-1.2%), 3 of which resulted in a change in 
      management (0.2%; 95% CI, 0.04%-0.5%). Seven AEs were bradydysrhythmias with a 
      heart rate of 45 or higher; the eighth patient had no change in symptoms and was 
      given atropine for a heart rate of 32. The other 3 AEs were an untreated 
      supraventricular tachycardia, a brief sinus pause that triggered a rate change in 
      intravenous nitroglycerin by the patient's nurse, and a run of premature 
      ventricular contractions after which heparin was administered. None of the 3 
      patients with a change in management was categorized as the lowest-risk. 
      CONCLUSIONS: Routine CEM in low-risk ED patients with chest pain results in an 
      excessive number of alarms, most of which require no change in management. In 
      these patients, the benefit of CEM may be limited, and given that 99.4% of alarms 
      were false, current CEM technology needs to be improved.
FAU - Atzema, Clare
AU  - Atzema C
AD  - Division of Emergency Medicine, Sunnybrook and Women's College Health Sciences 
      Centre, Toronto, ON, Canada. clare.atzema@ices.on.ca
FAU - Schull, Michael J
AU  - Schull MJ
FAU - Borgundvaag, Bjug
AU  - Borgundvaag B
FAU - Slaughter, Graham R D
AU  - Slaughter GR
FAU - Lee, Cheong K
AU  - Lee CK
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am J Emerg Med
JT  - The American journal of emergency medicine
JID - 8309942
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Arrhythmias, Cardiac/*diagnosis/etiology
MH  - Chest Pain/etiology/*physiopathology/therapy
MH  - Cohort Studies
MH  - *Electrocardiography
MH  - *Emergency Service, Hospital
MH  - False Positive Reactions
MH  - Feasibility Studies
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pilot Projects
MH  - Reproducibility of Results
MH  - Risk Assessment
EDAT- 2005/12/13 09:00
MHDA- 2006/03/01 09:00
CRDT- 2005/12/13 09:00
PHST- 2005/05/02 00:00 [accepted]
PHST- 2005/12/13 09:00 [pubmed]
PHST- 2006/03/01 09:00 [medline]
PHST- 2005/12/13 09:00 [entrez]
AID - S0735-6757(05)00273-1 [pii]
AID - 10.1016/j.ajem.2005.05.015 [doi]
PST - ppublish
SO  - Am J Emerg Med. 2006 Jan;24(1):62-7. doi: 10.1016/j.ajem.2005.05.015.