Monitoring the corrected QT in the acute care setting

A comparison of the 12-lead electrocardiogram and bedside monitor

Research output: Contribution to journalArticle

Abstract

Introduction: Prolongation of the QT interval is a well-recognized complication associated with many commonly used medications. Emergency Department monitoring of the corrected QT (QTc) both before and after medication administration is typically performed using the 12-lead electrocardiogram (ECG). The purpose of this study is to compare the QTc reported on the 12-lead ECG to that reported by single brand of bedside monitor. Methods: A convenience sample of emergency department patients over the age of 18 undergoing bedside monitoring and who had an ECG ordered by their treating physician were enrolled. These patients underwent simultaneous ECG and monitor QTc calculation. The primary outcome of interest was the correlation between the monitor and ECG QTc. Secondary outcomes included ability of each method to identify patients with a QTc >. 500. ms and the ability of each method to identify patients with a QTc <. 450. ms. Results: A total of 125 patients had simultaneous ECG and monitor QTc measurements recorded. There was moderate correlation between the monitor and ECG QTc (Pearson's correlation coefficient = 0.55). The median difference between the ECG QTc and the monitor QTc (ECG QTc minus monitor QTc) was -7. ms (IQR -23 to 11. ms). Conclusion: We found that there was moderate correlation between the QTc reported on the 12 lead ECG and that reported by the bedside monitor. This correlation is not strong enough to support the use of the bedside monitor as a substitute for the 12-lead ECG when evaluating a patient's QTc.

Original languageEnglish (US)
JournalAmerican Journal of Emergency Medicine
DOIs
StateAccepted/In press - 2017

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Electrocardiography
Hospital Emergency Service
Lead
Physicians

Keywords

  • QT interval
  • QT prolongation
  • QTc
  • Torsades de pointes

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

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title = "Monitoring the corrected QT in the acute care setting: A comparison of the 12-lead electrocardiogram and bedside monitor",
abstract = "Introduction: Prolongation of the QT interval is a well-recognized complication associated with many commonly used medications. Emergency Department monitoring of the corrected QT (QTc) both before and after medication administration is typically performed using the 12-lead electrocardiogram (ECG). The purpose of this study is to compare the QTc reported on the 12-lead ECG to that reported by single brand of bedside monitor. Methods: A convenience sample of emergency department patients over the age of 18 undergoing bedside monitoring and who had an ECG ordered by their treating physician were enrolled. These patients underwent simultaneous ECG and monitor QTc calculation. The primary outcome of interest was the correlation between the monitor and ECG QTc. Secondary outcomes included ability of each method to identify patients with a QTc >. 500. ms and the ability of each method to identify patients with a QTc <. 450. ms. Results: A total of 125 patients had simultaneous ECG and monitor QTc measurements recorded. There was moderate correlation between the monitor and ECG QTc (Pearson's correlation coefficient = 0.55). The median difference between the ECG QTc and the monitor QTc (ECG QTc minus monitor QTc) was -7. ms (IQR -23 to 11. ms). Conclusion: We found that there was moderate correlation between the QTc reported on the 12 lead ECG and that reported by the bedside monitor. This correlation is not strong enough to support the use of the bedside monitor as a substitute for the 12-lead ECG when evaluating a patient's QTc.",
keywords = "QT interval, QT prolongation, QTc, Torsades de pointes",
author = "James Chenoweth and Hougham, {Aaron M.} and Daniel Colby and Ford, {Jonathan B} and Jordan Sandhu and Albertson, {Timothy E} and Sutter, {Mark E}",
year = "2017",
doi = "10.1016/j.ajem.2017.10.012",
language = "English (US)",
journal = "American Journal of Emergency Medicine",
issn = "0735-6757",
publisher = "W.B. Saunders Ltd",

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TY - JOUR

T1 - Monitoring the corrected QT in the acute care setting

T2 - A comparison of the 12-lead electrocardiogram and bedside monitor

AU - Chenoweth, James

AU - Hougham, Aaron M.

AU - Colby, Daniel

AU - Ford, Jonathan B

AU - Sandhu, Jordan

AU - Albertson, Timothy E

AU - Sutter, Mark E

PY - 2017

Y1 - 2017

N2 - Introduction: Prolongation of the QT interval is a well-recognized complication associated with many commonly used medications. Emergency Department monitoring of the corrected QT (QTc) both before and after medication administration is typically performed using the 12-lead electrocardiogram (ECG). The purpose of this study is to compare the QTc reported on the 12-lead ECG to that reported by single brand of bedside monitor. Methods: A convenience sample of emergency department patients over the age of 18 undergoing bedside monitoring and who had an ECG ordered by their treating physician were enrolled. These patients underwent simultaneous ECG and monitor QTc calculation. The primary outcome of interest was the correlation between the monitor and ECG QTc. Secondary outcomes included ability of each method to identify patients with a QTc >. 500. ms and the ability of each method to identify patients with a QTc <. 450. ms. Results: A total of 125 patients had simultaneous ECG and monitor QTc measurements recorded. There was moderate correlation between the monitor and ECG QTc (Pearson's correlation coefficient = 0.55). The median difference between the ECG QTc and the monitor QTc (ECG QTc minus monitor QTc) was -7. ms (IQR -23 to 11. ms). Conclusion: We found that there was moderate correlation between the QTc reported on the 12 lead ECG and that reported by the bedside monitor. This correlation is not strong enough to support the use of the bedside monitor as a substitute for the 12-lead ECG when evaluating a patient's QTc.

AB - Introduction: Prolongation of the QT interval is a well-recognized complication associated with many commonly used medications. Emergency Department monitoring of the corrected QT (QTc) both before and after medication administration is typically performed using the 12-lead electrocardiogram (ECG). The purpose of this study is to compare the QTc reported on the 12-lead ECG to that reported by single brand of bedside monitor. Methods: A convenience sample of emergency department patients over the age of 18 undergoing bedside monitoring and who had an ECG ordered by their treating physician were enrolled. These patients underwent simultaneous ECG and monitor QTc calculation. The primary outcome of interest was the correlation between the monitor and ECG QTc. Secondary outcomes included ability of each method to identify patients with a QTc >. 500. ms and the ability of each method to identify patients with a QTc <. 450. ms. Results: A total of 125 patients had simultaneous ECG and monitor QTc measurements recorded. There was moderate correlation between the monitor and ECG QTc (Pearson's correlation coefficient = 0.55). The median difference between the ECG QTc and the monitor QTc (ECG QTc minus monitor QTc) was -7. ms (IQR -23 to 11. ms). Conclusion: We found that there was moderate correlation between the QTc reported on the 12 lead ECG and that reported by the bedside monitor. This correlation is not strong enough to support the use of the bedside monitor as a substitute for the 12-lead ECG when evaluating a patient's QTc.

KW - QT interval

KW - QT prolongation

KW - QTc

KW - Torsades de pointes

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