Chest Pain in the Emergency Department: Who Needs Monitoring?

Millions of patients present to emergency departments (EDs) with chest pain each year, and most undergo continuous cardiac monitoring for arrhythmias. In this analysis, Canadian researchers studied 992 patients with chest pain who were monitored in a single ED. Fourteen percent of patients ultimately were diagnosed with myocardial infarction, and 12% were diagnosed with unstable angina. Seventeen patients (1.7%) had serious arrhythmias requiring treatment in the ED.

A decision rule derived from the data suggested that patients could be removed from monitoring if they were pain free at presentation and had normal or nonspecific electrocardiograms. The rule identified all patients with serious arrhythmias, and the authors estimate that, had th…