Undiagnosed cardiovascular illness has been the cause of collapse during sports practice for a number of young athletes and the increasing reports of such cases is a cause of worry. In view of this, although some healthcare professionals have recommended that mandatory electrocardiogram (ECG) screenings be performed before participation in any sport, others have challenged the validity of such a requirement. The accuracy and effectiveness of pre-sport participation ECGs has been examined in a new research that will be published shortly in The Journal of Pediatrics.

A survey to find out the accuracy of ECG screenings was carried out by Dr. Allison Hill and colleagues from Stanford University School of Medicine and Lucile Packard Children's Hospital and Pediatric Cardiology Associates.

A total of 18 ECGs were interpreted by 53 pediatric cardiologists. Out of the 18 ECGs, 8 were from children with healthy hearts and 10 from children with heart conditions that could lead to sudden cardiac death. It was surprising that the overall accuracy of the interpretation by cardiologists' was just 67%, which is fairly low. Restriction to participate in sports was correctly imposed by the cardiologists in 81% of cases for children with heart conditions. In 74% of cases, they correctly allowed participation in sports for children with healthy hearts.

As Dr. Hill states,

"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."
The results of this survey demonstrate that due to inaccuracy of ECGs and the high error rate in ECG interpretation, pre-participation ECGs could result in unnecessary exclusion of healthy young people from participation in sports and vice versa. 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."

"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 believe that if pre-participation ECGs are made mandatory, it is very important that the doctors who interpret them are adequately trained.

"Accuracy of Interpretation of Preparticipation Screening Electrocardiograms"
Allison C. Hill, MD, Christina Y. Miyake, MD, MS, Staffor Grady, MD, and Anne M. Dubin, MD
The Journal of Pediatrics, DOI 10.1016/j.jpeds.2011.05.014, published by Elsevier.

Anne Hudsmith