Karolina Ho, Gopika K Ganesh, Shelvin Prasad, Thomas J Hoffmann, Amy Larsen, Cass Sandoval, Sarah Berger, Hildy Schell-Chaple, Fabio Badilini, Lynda A Mackin, Michele M Pelter
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引用次数: 0
Abstract
Background: In hospitalized patients, QT/QTc (heart rate corrected) prolongation on the electrocardiogram (ECG) increases the risk of torsade de pointes. Manual measurements are time-consuming and often inaccurate. Some bedside monitors automatically and continuously measure QT/QTc; however, the agreement between computerized versus nurse-measured values has not been evaluated.
Objective: The aim of this study was to examine the agreement between computerized QT/QTc and bedside and expert nurses who used electronic calipers.
Methods: This was a prospective observational study in 3 intensive care units. Up to 2 QT/QTc measurements (milliseconds) per patient were collected. Bland-Altman test was used to analyze measurement agreement.
Results: A total of 54 QT/QTc measurements from 34 patients admitted to the ICU were included. The mean difference (bias) for QT comparisons was as follows: computerized versus expert nurses, -11.04 ± 4.45 milliseconds (95% confidence interval [CI], -2.3 to -19.8; P = .016), and computerized versus bedside nurses, -13.72 ± 6.70 (95% CI, -0.70 to -26.8; P = .044). The mean bias for QTc comparisons was as follows: computerized versus expert nurses, -12.46 ± 5.80 (95% CI, -1.1 to -23.8; P = .035), and computerized versus bedside nurses, -18.49 ± 7.90 (95% CI, -3.0 to -33.9; P = .022).
Conclusion: Computerized QT/QTc measurements calculated by bedside monitor software and measurements performed by nurses were in close agreement; statistically significant differences were found, but differences were less than 20 milliseconds (on-half of a small box), indicating no clinical significance. Computerized measurements may be a suitable alternative to nurse-measured QT/QTc. This could reduce inaccuracies and nurse burden while increasing adherence to practice recommendations. Further research comparing computerized QT/QTc from bedside monitoring to standard 12-lead electrocardiogram in a larger sample, including non-ICU patients, is needed.
期刊介绍：
Official journal of the Preventive Cardiovascular Nurses Association, Journal of Cardiovascular Nursing is one of the leading journals for advanced practice nurses in cardiovascular care, providing thorough coverage of timely topics and information that is extremely practical for daily, on-the-job use. Each issue addresses the physiologic, psychologic, and social needs of cardiovascular patients and their families in a variety of environments. Regular columns include By the Bedside, Progress in Prevention, Pharmacology, Dysrhythmias, and Outcomes Research.
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