Clinical Decision Rule of Gatien et al for Discontinuing Cardiac Monitoring of an Adult with Chest Pain in the Emergency Department (Ottawa Chest Pain Cardiac Monitoring Rule)

 

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

 

Performance:

• The sensitivity for serious arrhythmias was 100%.

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

 

Limitations:

• The rule needs to be prospectively validated.