Incidents of young athletes collapsing during sports practice due to an undiagnosed heart condition are alarming, and have led some health care professionals to call for mandatory electrocardiogram (ECG) screenings before sport participation. Others, however, question the validity of such a mandate. A new study soon to be published in The Journal of Pediatrics examines the accuracy and effectiveness of pre-sport participation ECGs.
Dr. Allison Hill and colleagues from Stanford University School of Medicine and Lucile Packard Children’s Hospital and Pediatric Cardiology Associates conducted a survey to test the accuracy of ECG screenings. Fifty-three pediatric cardiologists were asked to interpret 18 ECGs, 8 from children with healthy hearts and 10 from children with heart conditions that could lead to sudden cardiac death. The accuracy of the cardiologists’ interpretations was fairly low; the average score for overall accuracy was 67%. The cardiologists correctly restricted sport participation 81% of the time for children with heart conditions, and they correctly allowed participation 74% of the time for children with healthy hearts.
As Dr. Hill explains, “One problem with interpreting athletes’ ECGs is that, as athletes’ hearts grow stronger, they may get somewhat larger and beat more slowly. Although these changes are normal for a well-trained athlete, they can look similar on ECG scans to defects that predispose people to sudden cardiac death.” As the test scores demonstrate, this similarity could lead to unnecessary exclusion of healthy young people from sport participation. And the reverse can also be true. According to Dr. Hill, “Some young athletes who are predisposed to sudden cardiac death may be given a clean bill of health based on a flawed ECG interpretation.”
The researchers suggest that because ECGs are not always accurate and can be difficult to interpret, they may not be the perfect test for pre-screening athletes for heart conditions. “Although other countries have enacted laws mandating ECG screening for their athletes,” Dr. Hill states, “the difficulty of interpreting ECG results, combined with the very large population of young athletes in the United States (over 10.7 million), may make such laws impractical.” She and her colleagues suggest that, if young athletes are to be screened in this way, the physicians interpreting the ECG should be trained appropriately.
The study, reported in “Accuracy of Interpretation of Preparticipation Screening Electrocardiograms” by Allison C. Hill, MD, Christina Y. Miyake, MD, MS, Staffor Grady, MD, and Anne M. Dubin, MD, appears in The Journal of Pediatrics, DOI 10.1016/j.jpeds.2011.05.014, published by Elsevier.