Screening Electrocardiograms in Cocaine-Positive Chest Pain-Free Psychiatric Patients Requiring Medical Screening

Area of Science:

• Emergency Medicine
• Cardiology
• Psychiatry

Background:

• Current practice involves screening electrocardiograms (ECGs) for all psychiatric patients testing positive for cocaine.
• This practice is standard in large urban academic emergency departments (EDs).

Purpose of the Study:

• To evaluate the impact of ECGs in chest pain-free psychiatric patients who tested positive for cocaine.
• To determine the diagnostic yield of ECGs in this specific patient population.

Main Methods:

• Retrospective chart review of adult ED patients from January 2014 to December 2015.
• Included patients tested positive for cocaine and were without chest pain.
• Excluded patients with chest pain or missing ECG data; evaluated disposition and cardiac work-up.

Main Results:

• 853 patients met inclusion criteria; 95% had normal ECGs (812/853).
• Abnormal ECGs were found in 5% (41/853) of patients.
• No acute myocardial ischemia or infarction was identified in patients with abnormal ECGs.

Conclusions:

• Most cocaine-using psychiatric patients without chest pain present with normal ECGs.
• Abnormal ECG findings in this group did not correlate with acute cardiac events.
• Routine ECG screening may not be necessary for chest pain-free, cocaine-positive psychiatric patients.