Screening for QT Prolongation in the Emergency Department: Is There a Better “Rule of Thumb?”.
Introduction: Identification of QT prolongation in the emergency department (ED) is critical for appropriate monitoring, disposition, and treatment of patients at risk for torsades de pointes (TdP). Unfortunately, identifying prolonged QT is not straightforward. Computer algorithms are unreliable in...
| Publicado en: | Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Vol. 21; no. 2; pp. 226 - 233 |
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| Autores principales: | , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
Mar2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=142114071&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 142114071 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 1936900X 8B61 jtl: Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health issn: 1936900X maglogo: N pubinfo: dt: Mar2020 vid: 21 iid: 2 pid: 29816 pub: Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health place: Orange, California artinfo: ui: 142114071 142114071 142114071 10.5811/westjem.2019.10.40381 142114071 ppf: 226 ppct: 7 formats: fmt: @attributes: type: P tig: atl: Screening for QT Prolongation in the Emergency Department: Is There a Better “Rule of Thumb?”. aug: au: Rischall, Megan L. Smith, Stephen W. Friedman, Ari B. affil: Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, Minnesota. sug: subj: Emergency Service Long QT Syndrome Diagnosis Heart Rate Monitoring, Physiologic Methods Health Screening Methods Emergency Patients Patient Safety Human Problem Solving Electrocardiography Comparative Studies Bradycardia Diagnosis Emergency Medicine Health Personnel Education ab: Introduction: Identification of QT prolongation in the emergency department (ED) is critical for appropriate monitoring, disposition, and treatment of patients at risk for torsades de pointes (TdP). Unfortunately, identifying prolonged QT is not straightforward. Computer algorithms are unreliable in identifying prolonged QT. Manual QT-interval assessment methods, including QT correction formulas and the QT nomogram, are time-consuming and are not ideal screening tools in the ED. Many emergency clinicians rely on the “rule of thumb” or “Half the RR” rule (Half-RR) as an initial screening method, but prior studies have shown that the Half-RR rule performs poorly as compared to other QT assessment methods. We sought to characterize the problems associated with the Half-RR rule and find a modified screening tool to more safely assess the QT interval of ED patients for prolonged QT. Methods: We created graphs comparing the prediction of the Half-RR rule to other common QT assessment methods for a spectrum of QT and heart rate pairs. We then proposed various modifications to the Half-RR rule and assessed these modifications to find an improved “rule of thumb.” Results: When compared to other methods of QT correction, the Half-RR rule appears to be more conservative at normal and elevated heart rates, making it a safe initial screening tool. However, in bradycardia, the Half-RR rule is not sufficiently sensitive in identifying prolonged QT. Adding a fixed QT cutoff of 485 milliseconds (ms) increases the sensitivity of the rule in bradycardia, creating a safer initial screening tool. Conclusion: For a rapid and more sensitive screening evaluation of the QT interval on electrocardiograms in the ED, we propose combining use of the Half-RR rule at normal and elevated heart rates with a fixed uncorrected QT cutoff of 485 ms in bradycardia. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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