Article Text

PDF
101 OUTCOMES OF EMERGENCY DEPARTMENT PATIENTS WITH NONDIAGNOSITIC ELECTROCARDIOGRAMS
  1. J. K. Lam,
  2. M. L. McConahy,
  3. R. Steele
  1. Loma Linda, CA.

Abstract

Introduction “Doctor what is causing my Chest Pain (CP)?” This is a common problem in the Emergency Department (ED). The question of what is causing the CP can be a very difficult one. EKGs are used as the first diagnostic step. An EKG diagnostic of acute MI is an easy answer but what about a more common problem, the patient with a nondiagnostic EKG? If the EKG is nondiagnostic or normal does that mean the CP is non-cardiac?

Objective To evaluate outcomes of ED CP patients with normal or non-specific EKG's.

Design, Setting, and Patients A prospective cohort study in an urban academic institution with 60,000 annual ED visits in which 269 patients with chest pain were enrolled.

Setting, and Patients A prospective cohort study in an urban academic institution with 60,000 annual ED visits in which 269 patients with chest pain were enrolled. Inclusion Criteria: ED CP patients with nondiagnostic EKGs were determined to be low risk because of a normal (n=121) or non-specific non-ischemic (n=148) EKGs. Non-specific non-ischemic EKG's were defined by the ED doctor caring for the patient to

Inclusion Criteria ED CP patients with nondiagnostic EKGs were determined to be low risk because of a normal (n=121) or non-specific non-ischemic (n=148) EKGs. Non-specific non-ischemic EKG's were defined by the ED doctor caring for the patient to not represent ischemia at the time of evaluation (s-t segment abnormalities were determined to be non-acute and non-ischemic). The initial EKG obtained in the ED was correlated to the hospital course, treatment, discharge diagnosis and phone call follow-up.

Exclusion Criteria Patients with EKG criteria consistent with acute myocardial infarction or active ischemia.

Main Outcome Measures CP secondary to Coronary Artery Disease (CAD) was determined to be present based on cardiac angiogram results (stenosis ≥70%), + cardiac stress test, or +cardiac enzymes. CP not caused by CAD was determined based on a normal cardiac work-up associated with an unremarkable hospital discharge and a follow-up phone call at 2–;4weeks showing no cardiac event.

Results CAD was determined to be the cause of CP in 12% of the patients with nondiagnostic EKGs. Nondiagnostic initial EKGs had a Sensitivity of 33% for CAD. The Negative Predictive Value of a nondiagnostic EKG was 69%. Even with a completely normal EKG (n=121) 5% of those patients with were diagnosed with CAD.

Conclusion A normal or non-specific initial EKG does not reliably exclude CAD as the cause of CP.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.