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Defining abnormal electrocardiography in adult emergency department syncope patients: the Ottawa Electrocardiographic Criteria.
MedLine Citation:
PMID:  22813399     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
ABSTRACTBackground:Previous studies have indicated that the suboptimal performance of the San Francisco Syncope Rule (SFSR) is likely due to the misclassification of the "abnormal electrocardiogram (ECG)" variable. We sought to identify specific emergency department (ED) ECG and cardiac monitor abnormalities that better predict cardiac outcomes within 30 days in adult ED syncope patients.Methods:This health records review included patients 16 years or older with syncope and excluded patients with ongoing altered mental status, alcohol or illicit drug use, seizure, head injury leading to loss of consciousness, or severe trauma requiring admission. We collected patient characteristics, 22 ECG variables, cardiac monitoring abnormalities, SFSR "abnormal ECG" criteria, and outcome (death, myocardial infarction, arrhythmias, or cardiac procedures) data. Recursive partitioning was used to develop the "Ottawa Electrocardiographic Criteria."Results:Among 505 included patient visits, 27 (5.3%) had serious cardiac outcomes. We found that patients were at risk for cardiac outcomes within 30 days if any of the following were present: second-degree Mobitz type 2 or third-degree atrioventricular (AV) block, bundle branch block with first-degree AV block, right bundle branch with left anterior or posterior fascicular block, new ischemic changes, nonsinus rhythm, left axis deviation, or ED cardiac monitor abnormalities. The sensitivity and specificity of the Ottawa Electrocardiographic Criteria were 96% (95% CI 80-100) and 76% (95% CI 75-76), respectively.Conclusion:We successfully identified specific ED ECG and cardiac monitor abnormalities, which we termed the Ottawa Electrocardiographic Criteria, that predict serious cardiac outcomes in adult ED syncope patients. Further studies are required to identify which adult ED syncope patients require cardiac monitoring in the ED and the optimal duration of monitoring and to confirm the accuracy of these criteria.
Authors:
Venkatesh Thiruganasambandamoorthy; Erik P Hess; Ekaterina Turko; My-Linh Tran; George A Wells; Ian G Stiell
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  CJEM     Volume:  14     ISSN:  1481-8035     ISO Abbreviation:  CJEM     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-07-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100893237     Medline TA:  CJEM     Country:  United States    
Other Details:
Languages:  eng     Pagination:  248-58     Citation Subset:  IM    
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