Madsen Troy, Bledsoe Joseph, Bossart Philip
School of Medicine, University of Utah, Salt Lake City, Utah 84132, USA.
Crit Pathw Cardiol. 2009 Mar;8(1):34-7. doi: 10.1097/HPC.0b013e3181978fc0.
Our emergency department (ED) observation unit specifically excludes patients with "significant" electrocardiogram (EKG) findings, but patients may be admitted with "nonspecific" EKG findings. We evaluated whether physician documentation of nonspecific findings predicted eventual admission to an inpatient unit from the observation unit. We reviewed the charts of all chest pain patients admitted to our ED observation unit over a 14-month period. We recorded patients as having documented nonspecific EKG findings if the ED physician stated in the chart that the patient had nonspecific ST segment, T-wave, or Q-wave findings. We recorded baseline characteristics and admission rates among patients. Results were analyzed with chi2 statistics. Five hundred thirty-one chest pain patients were admitted to the observation unit during the study period, and 79 patients (14.9%) had documented nonspecific EKG findings. Patients (22.8%) with documented nonspecific EKG findings were admitted to an inpatient unit from the observation unit, compared with 14.2% of patients without documented nonspecific EKG findings (P = 0.041). Patients with documented nonspecific EKG changes also had higher rates of positive stress testing (17.5% vs. 10.5%, P = 0.103) and stent placement (5.1% vs. 3.3%, P = 0.309), although these were not statistically significant. Patients with documented nonspecific EKG findings were admitted to an inpatient unit from the observation unit at higher rates than those without these findings. Physicians may wish to use the ED EKG more effectively in screening patients for admission to the ED observation unit.
我们的急诊科观察单元明确排除有“显著”心电图（EKG）表现的患者，但有“非特异性”EKG表现的患者可能会被收治。我们评估了医生记录的非特异性表现是否能预测患者最终从观察单元转入住院部。我们回顾了在14个月期间收治到我们急诊科观察单元的所有胸痛患者的病历。如果急诊科医生在病历中注明患者有非特异性ST段、T波或Q波表现，我们就记录该患者有记录在案的非特异性EKG表现。我们记录了患者的基线特征和收治率。结果采用卡方统计进行分析。在研究期间，有531名胸痛患者被收治到观察单元，其中79名患者（14.9%）有记录在案的非特异性EKG表现。有记录在案的非特异性EKG表现的患者中，有22.8%从观察单元转入住院部，而没有记录在案的非特异性EKG表现的患者这一比例为14.2%（P = 0.041）。有记录在案的非特异性EKG改变的患者进行应激试验阳性的比例也更高（17.5%对10.5%，P = 0.103），以及支架置入的比例更高（5.1%对3.3%，P = 0.309），尽管这些差异无统计学意义。有记录在案的非特异性EKG表现的患者从观察单元转入住院部的比例高于没有这些表现的患者。医生可能希望更有效地利用急诊科EKG来筛选患者是否适合收治到急诊科观察单元。
