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Usefulness of automated serial 12-lead ECG monitoring during the initial emergency department evaluation of patients with chest pain.
Ann Emerg Med. 1998 Jan; 31(1):3-11.AE

Abstract

STUDY OBJECTIVE

To determine whether the use of automated serial 12-lead ECG monitoring (SECG) is more sensitive and specific than the initial 12-lead ECG in the detection of injury and ischemia in patients with acute coronary syndromes (ACS) during the initial ED evaluation of patients with chest pain.

METHODS

A prospective observational study was performed in 1,000 patients with chest pain who were admitted to a university teaching hospital and who underwent continuous ST-segment monitoring with SECG during the initial ED evaluation. The initial ECG was obtained on presentation, and SECG readings were obtained at least every 20 minutes during the ED evaluation. Diagnostic abnormalities on the initial ECG were defined as injury or ischemia. Diagnostic changes on SECG were defined as evolving injury, evolving ischemia, new injury, or new ischemia. ACS was defined as acute myocardial infarction (AMI), recent myocardial infarction or unstable angina.

RESULTS

A diagnostic SECG was more sensitive than a diagnostic initial ECG for detection of AMI (68.1% versus 55.4%; P < .0001) and ACS (34.2% versus 27.5%; P < .0001). A diagnostic SECG was more specific than a diagnostic initial ECG for detection of ACS (99.4% versus 97.1%; P < .01). SECG detected injury in an additional 16.2% of AMI patients compared with the initial ECG (61.8% versus 45.6%; P < .0001; 95% confidence interval for difference of proportions, 10.9% to 21.4%).

CONCLUSION

SECG during the initial ED evaluation is more sensitive and more specific than the initial ECG in the identification of ACS. Patients with a diagnostic SECG need intensive antiischemic therapy, evaluation for reperfusion therapy, and admission to an ICU.

Authors+Show Affiliations

Department of Emergency Medicine, Erlanger Medical Center, University of Tennessee College of Medicine, Chattanooga, USA. PKUC36A@Prodigy.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

9437335

Citation

Fesmire, F M., et al. "Usefulness of Automated Serial 12-lead ECG Monitoring During the Initial Emergency Department Evaluation of Patients With Chest Pain." Annals of Emergency Medicine, vol. 31, no. 1, 1998, pp. 3-11.
Fesmire FM, Percy RF, Bardoner JB, et al. Usefulness of automated serial 12-lead ECG monitoring during the initial emergency department evaluation of patients with chest pain. Ann Emerg Med. 1998;31(1):3-11.
Fesmire, F. M., Percy, R. F., Bardoner, J. B., Wharton, D. R., & Calhoun, F. B. (1998). Usefulness of automated serial 12-lead ECG monitoring during the initial emergency department evaluation of patients with chest pain. Annals of Emergency Medicine, 31(1), 3-11.
Fesmire FM, et al. Usefulness of Automated Serial 12-lead ECG Monitoring During the Initial Emergency Department Evaluation of Patients With Chest Pain. Ann Emerg Med. 1998;31(1):3-11. PubMed PMID: 9437335.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Usefulness of automated serial 12-lead ECG monitoring during the initial emergency department evaluation of patients with chest pain. AU - Fesmire,F M, AU - Percy,R F, AU - Bardoner,J B, AU - Wharton,D R, AU - Calhoun,F B, PY - 1998/1/23/pubmed PY - 1998/1/23/medline PY - 1998/1/23/entrez SP - 3 EP - 11 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 31 IS - 1 N2 - STUDY OBJECTIVE: To determine whether the use of automated serial 12-lead ECG monitoring (SECG) is more sensitive and specific than the initial 12-lead ECG in the detection of injury and ischemia in patients with acute coronary syndromes (ACS) during the initial ED evaluation of patients with chest pain. METHODS: A prospective observational study was performed in 1,000 patients with chest pain who were admitted to a university teaching hospital and who underwent continuous ST-segment monitoring with SECG during the initial ED evaluation. The initial ECG was obtained on presentation, and SECG readings were obtained at least every 20 minutes during the ED evaluation. Diagnostic abnormalities on the initial ECG were defined as injury or ischemia. Diagnostic changes on SECG were defined as evolving injury, evolving ischemia, new injury, or new ischemia. ACS was defined as acute myocardial infarction (AMI), recent myocardial infarction or unstable angina. RESULTS: A diagnostic SECG was more sensitive than a diagnostic initial ECG for detection of AMI (68.1% versus 55.4%; P < .0001) and ACS (34.2% versus 27.5%; P < .0001). A diagnostic SECG was more specific than a diagnostic initial ECG for detection of ACS (99.4% versus 97.1%; P < .01). SECG detected injury in an additional 16.2% of AMI patients compared with the initial ECG (61.8% versus 45.6%; P < .0001; 95% confidence interval for difference of proportions, 10.9% to 21.4%). CONCLUSION: SECG during the initial ED evaluation is more sensitive and more specific than the initial ECG in the identification of ACS. Patients with a diagnostic SECG need intensive antiischemic therapy, evaluation for reperfusion therapy, and admission to an ICU. SN - 0196-0644 UR - https://www.unboundmedicine.com/medline/citation/9437335/Usefulness_of_automated_serial_12_lead_ECG_monitoring_during_the_initial_emergency_department_evaluation_of_patients_with_chest_pain_ DB - PRIME DP - Unbound Medicine ER -