Gatien et al developed a clinical decision rule to decide if continuous cardiac monitoring can be safely discontinued in an adult with chest pain in the Emergency Department (ED). This can reduce unnecessary monitoring of low risk patients. The authors are from the University of Ottawa and the University of Toronto in Canada.


Patient selection: adult with chest pain


Endpoint: detection of a serious cardiac arrhythmia by cardiac monitoring


Basis for rule: serious arrhythmias are uncommon in monitored chest pain patients in the ED (if absent on initial assessment)


Criteria for discontinuing continous cardiac monitoring - both of the following:

(1) absence of chest pain at the initial physician assessment

(2) ECG normal OR shows only non-specific findings


Indications for continued monitoring:

(1) current chest pain

(2) ECG shows acute ischemia or infarction

(3) ECG shows an old infarct

(4) ECG shows left bundle branch block (LBBB)

(5) ECG show paced rhythm

(6) ECG shows other significant findings



• The sensitivity for serious arrhythmias was 100%.

• Monitoring could be discontinue in about a third of patients.



• The rule needs to be prospectively validated.


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