Level 3: Lacking direct evidence
Conventional cardiac screening for young athletes involves routine history and physical exam. A recent cross-sectional study evaluated the effects of adding ECG to pre-participation screening in 510 college athletes (Ann Intern Med. 2010;152:269-275). All athletes also had transthoracic echocardiography (TTE). Of 11 athletes found to have cardiac abnormalities on TTE, five were detected by conventional screening alone, and 10 were detected using conventional screening plus ECG. Using ECG improved the sensitivity of screening from 45.5% to 90.9% and the negative predictive value from 98.7% to 99.8%. However, ECG was also associated with an increase in false positives from 5.5% to 16.9%.
Another study evaluated the cost-effectiveness of adding ECG to the screening of high school and college athletes. ECG was associated with a cost increase of $42,000 per life-year saved, with an estimated saving of two life-years per 1,000 athletes screened (Ann Intern Med. 2010;152:276-286).