PT - JOURNAL ARTICLE AU - Matt Reed AU - Neil Grubb AU - Chris Lang AU - Rachel O’Brien AU - Kirsty Simpson AU - Mia Padarenga AU - Alison Grant AU - Sharon Tuck AU - Liza Keating AU - Frank Coffey AU - Lucy Jones AU - Tim Harris AU - Gavin Lloyd AU - James Gagg AU - Jason Smith TI - 018 Clinician prediction of cardiac arrhythmia in patients presenting to the ED with palpitation or pre-syncope AID - 10.1136/emermed-2019-RCEM.18 DP - 2019 Dec 01 TA - Emergency Medicine Journal PG - 783--784 VI - 36 IP - 12 4099 - http://emj.bmj.com/content/36/12/783.2.short 4100 - http://emj.bmj.com/content/36/12/783.2.full SO - Emerg Med J2019 Dec 01; 36 AB - The IPED study showed that use of a smartphone-based event recorder in ED patients presenting with palpitation or pre-syncope, increased the number of patients in whom an ECG was captured during symptoms over five-fold to more than 55% at 90 days (Reed MJ et al. Lancet eClinical Medicine 2019; 8: 37–46).This pre-planned analysis looked at the ability of ED clinicians to predict cardiac arrhythmia in patients presenting to the ED with palpitation or pre-syncope.Pre-planned sub study analysis of a randomised controlled multi-centre trial. Participants ≥16 years old presenting to 10 UK hospital EDs with palpitation or pre-syncope whose underlying ECG rhythm during these episodes remained undiagnosed after ED assessmentwere enrolled. The treating ED clinician was asked to rate the likelihood of underlying cardiac arrhythmia ranging from 1 (least likely) to 10 (most likely). Participants were then randomised to either an intervention group using a smartphone-based event recorder or a standard care control group. Primary endpoint of this sub study was symptomatic cardiac arrhythmia at 90 days.243 patients were enrolled. 6 patients had no ED clinician likelihood rating recorded and two further patients were lost to follow-up leaving 235 available for analysis. There were 12 patients recording a symptomatic cardiac arrhythmia at 90 days. These were atrial fibrillation (8), SVT (3), sinus bradycardia (<40 bpm; 1) and atrial flutter (1). One patient recorded 2 categories of arrhythmia. The AUC for prediction of cardiac arrhythmia was 0.81 (95% CI; 0.71–0.90). An ED clinician likelihood rating of 5 or more had 92% sensitivity and 59% specificity for predicting cardiac arrhythmia.Abstract 018 Figure 1 ROC analysis of ED clinician likelihood rating for symptomatic cardiac dysrhythmia at 90 daysConclusion ED clinicians are able to predict the liklihood of cardiac arrhythmia in patients presenting to the ED with palpitation or pre-syncope with reasonable accuracy.