The yield of the routine admission electrocardiogram. A study in a general medical service.

To evaluate the usefulness of the admission electrocardiogram, we prospectively studied 1410 patients admitted to a general medical service. The patients' history and physical examination were analyzed, and then the electrocardiogram was evaluated to determine whether it added new information. Fifty-two admission electrocardiograms added unique information; 31 established a new diagnosis, 28 of which changed management. Twenty-one electrocardiograms suggested a new diagnosis, 13 of which proved correct. Only age and a clinically evident cardiac abnormality predicted the yield of the admission electrocardiogram. Among patients with cardiac abnormalities, electrocardiogram yield was 8.5% in those 45 years or older and 2.5% in those younger. Among patients without cardiac abnormality, electrocardiogram yield was 1.0% overall and its cost-effectiveness was $24 000 per year of life saved. An admission electrocardiogram infrequently added new information to the clinical evaluation, but was useful when it did. Admission electrocardiograms are as cost-effective as many accepted medical practices.