Is cardiac monitoring during transport of low-risk chest pain patients from the emergency department necessary?

OBJECTIVE

Incidence of life threatening arrhythmia for patients who present to the ED with low-risk chest pain (CP) (non-ischaemic electrocardiograms and normal cardiac marker profiles) is rare. These patients are often transported with cardiac monitoring by nurse escort from the ED. We aimed to show that this group of patients are at low risk of experiencing life-threatening arrhythmia disturbances.

METHODS

This was a prospective, observational study of ED low-risk CP patients who presented in the period September 2005 and March 2006 and were transported with cardiac monitoring. Data were collected via chart review, and nurse escorts prospectively documented transport details. The primary study outcome was the development of a life threatening arrhythmia requiring treatment during transport from the ED. Data analysis included descriptive statistics and interrater agreement.

RESULTS

During the study period there were 231 patients admitted to monitored beds from the ED, of whom 170 (74%) were low risk and enrolled in the study. No patient sustained an adverse event during transport from the ED (0%; 95% confidence interval 0-2.2%). Mean (+/-SD) time required for nurse escort to and from the radiology department and coronary care unit was 9.0 (+/-3.1) and 16 (+/-6.5) min, respectively.

CONCLUSIONS

CP patients who present to the ED with normal electrocardiograms and cardiac marker profiles are at low risk (<1%) of experiencing an adverse event during transport from the ED. This subset of patients might not require cardiac monitoring or nurse escort during transportation from the ED.