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The Yield of the Routine Admission Electrocardiogram: A Study in a General Medical Service

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Grant support: in part by grants from the Andrew W. Mellon Foundation, the Duke Endowment, and research grant HL-17670 from the National Heart, Lung and Blood Institute.

▸Requests for reprints should be addressed to Mark A. Hlatky, M.D.; Box 31265, Duke University Medical Center; Durham, NC 27710.

DUKE MEDICAL HOUSE STAFF; Durham, North Carolina

© 1985 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1985;103(4):590-595. doi:10.7326/0003-4819-103-4-590
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To evaluate the usefulness of the admission electrocardiogram, we prospectively studied 1410 patients admitted to a general medical service. The patients' history and physical examination were analyzed, and then the electrocardiogram was evaluated to determine whether it added new information. Fifty-two admission electrocardiograms added unique information; 31 established a new diagnosis, 28 of which changed management. Twenty-one electrocardiograms suggested a new diagnosis, 13 of which proved correct. Only age and a clinically evident cardiac abnormality predicted the yield of the admission electrocardiogram. Among patients with cardiac abnormalities, electrocardiogram yield was 8.5% in those 45 years or older and 2.5% in those younger. Among patients without cardiac abnormality, electrocardiogram yield was 1.0% overall and its cost-effectiveness was $24 000 per year of life saved. An admission electrocardiogram infrequently added new information to the clinical evaluation, but was useful when it did. Admission electrocardiograms are as cost-effective as many accepted medical practices.





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