Intervention in the Timeliness of Two Electrocardiography Types for Patients in the Emergency Department With Chest Pain: Randomized Controlled Trial

Abstract

Background: In the emergency department (ED), the result obtained using the 12-lead electrocardiography (ECG) is the basis for diagnosing and treating patients with chest pain. It was found that performing ECG at the appropriate time could improve treatment outcomes. Hence, a wearable ECG device with a timer can ensure that the findings are continuously recorded.

Objective: We aimed to compare the time accuracy of a single-patch 12-lead ECG (SP-ECG) with that of conventional ECG (C-ECG). We hypothesized that SP-ECG would result in better time accuracy.

Methods: Adult patients who visited the emergency room with chest pain but were not in shock were randomly assigned to one of the following 2 groups: the SP-ECG group or the C-ECG group. The final analysis included 33 (92%) of the 36 patients recruited. The primary outcome was the comparison of the time taken by the 2 groups to record the ECG. The average ages of the participants in the SP-ECG and C-ECG groups were 63.7 (SD 18.4) and 58.1 (SD 12.4) years, respectively.

Results: With a power of 0.95 and effect sizes of 0.05 and 1.36, the minimum number of samples was calculated. The minimum sample size for each SP-ECG and C-ECG group is 15.36 participants, assuming a 20% dropout rate. As a result, 36 patients with chest pain participated, and 33 of them were analyzed. The timeliness of SP-ECG and C-ECG for the first follow-up ECG was 87.5% and 47.0%, respectively (P=.74). It was 75.0% and 35.2% at the second follow-up, respectively (P=.71).

Conclusions: Continuous ECG monitoring with minimal interference from other examinations is feasible and essential in complex ED situations. However, the precision of SP-ECG has not yet been proved. Nevertheless, the application of SP-ECG is expected to improve overcrowding and human resource shortages in EDs, though more research is needed.

Trial registration: ClinicalTrials.gov NCT04114760; https://ichgcp.net/clinical-trials-registry/NCT04114760.

Keywords: ECG; EKG; accuracy; angina; cardiac; cardiology; chest; diagnose; diagnosis; electrocardiogram; electrocardiography; emergency; emergency department; heart; imaging; pain; randomization; randomized; wireless technology.

Conflict of interest statement

Conflicts of Interest: None declared.

©Suyoung Yoo, Hansol Chang, Taerim kim, Hee yoon, Sung Yeon Hwang, Tae Gun Shin, Min Seob Sim, Ik joon Jo, Jin-Ho Choi, Won Chul Cha. Originally published in the Interactive Journal of Medical Research (https://www.i-jmr.org/), 13.09.2022.

Figures

Figure 1

Study protocol. C-ECG: conventional electrocardiography (ECG); SP-ECG: single-patch 12-lead ECG.

Figure 2

Design configuration. 1. Main socket: socket of the patch for performing 12-lead electrocardiography. 2. Single-patch–type electrode. LA: left arm; RA: right arm; RL: right leg; V1-V4: voltage1-voltage.

Figure 3

System architecture of the single-patch 12-lead electrocardiography (ECG). 8 ch DC: converts an amplified analog signal into a digital signal;amplifier: amplifies analog voltage obtained from the electrodes; digital signal processing: computes received digital signals as ECG signals through digital operations; display: converts output processed ECG data into a visualization graph; HPF (high-pass filter): eliminates low-frequency noise; LA: left arm; LL: left leg; LPF (low-pass filter): eliminates high-frequency noise; notch (notch filter): eliminates noise at a certain frequency, eliminates 60-Hz noise used for commercial power sources; RA: right arm; RL: right leg; storage: stores processed ECG data; V1-V4: voltage1-voltage4; WCT: Wilson’s Central Terminal.

Figure 4

Timing of electrocardiography measurements (gray areas indicate accurate time intervals). C-ECG: conventional electrocardiography (ECG); SP-ECG: single-patch 12-lead ECG.