Key result
Computerized bedside monitors closely match expert nurse QTc measurements with an insignificant ~12 ms bias.
Why the study?
Manual QT/QTc interval measurements are time-consuming and often inaccurate, but agreement between automated continuous bedside monitor measurements and nurse-measured values had not been evaluated.
Does computerized QT/QTc measurement agree with nurse-measured values using electronic calipers in ICU patients?
Observational (n=34)
Yes
Does computerized QT/QTc measurement agree with nurse-measured values using electronic calipers in ICU patients?
Effect estimate: Mean bias -12.46 ms (95% CI -1.1 to -23.8)
p-value: p=.035
Computerized QT/QTc measurements from bedside monitors show close clinical agreement with nurse-measured values using electronic calipers, suggesting they are a suitable alternative to reduce nurse burden.
May ease ICU nurse QTc workload; leaves open prospective validation before routine adoption.
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.
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Ho et al. (2023) conducted an observational in Intensive care unit patients (n=34). Computerized QT/QTc measurements vs. Nurse-measured QT/QTc using electronic calipers was evaluated on Agreement between computerized and expert nurse QTc measurements (Mean bias -12.46 ms, 95% CI -1.1 to -23.8, p=.035). Computerized QT/QTc measurements by bedside monitors showed close agreement with expert nurse measurements, with a clinically insignificant mean QTc bias of -12.46 ms (95% CI, -1.1 to -23.8; P=.035).
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