Emergency department admissions to inpatient cardiac telemetry beds: A prospective cohort study of risk stratification and outcomes

PURPOSE: Little is known about physicians' use of inpatient cardiac telemet ry units among emergency department patients at risk for cardiac complicati ons. We therefore studied the outcomes of patients admitted to inpatient tt lt metry beds to identify a subset of patients from whom cardiac monitorin g could be withheld safely. SUBJECTS AND METHODS: We conducted a prospective cohort study of 1,033 cons ecutive adult patients admitted to an inpatient telemetry unit from the eme rgency department of a 700-bed urban public teaching hospital. Subjects wit h or without chest pain were risk-stratified using a prediction rule and ob served for in-hospital cardiac complications, acute myocardial infarction, and transfer to an intensive care unit (ICU). RESULTS: There were no significant differences between patients with (n = 6 77) or patients without chest pain (n = 356) in the rates of major cardiac complications, myocardial infarctions, or transfers to an ICU. Among 318 pa tients with chest pain who were classified as being very low risk, none suf fered major complications (negative predictive value 100%; 95% confidence i nterval [CI]: 98.8% to 100%). Among 214 very low risk patients without ches t pain, 1 (0.5%) had a major complication (negative predictive value 99.5%; 95% CI: 97.4% to 99.9%). CONCLUSIONS: The prediction rule accurately identified patients with or wit hout chest pain who were at very low risk Of major complications, identifyi ng a subset from whom cardiac monitoring could be withheld safely. (C) 2001 by Excerpta Medica, Inc.