Electrocardiogram in Preparticipation Athletic Evaluations among Insured Youths

• Published in: The Journal of pediatrics Vol. 167; no. 4; pp. 804 - 809.e1
• Main Authors: Burns, Kristin M., MD, Encinosa, William E., PhD, Pearson, Gail D., MD, ScD, Kaltman, Jonathan R., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2015
• Subjects: Adolescent; Adult; Cardiology - methods; Cardiology - standards; Child; Child, Preschool; Electrocardiography - utilization; False Positive Reactions; Female; Heart Diseases - diagnosis; Humans; Insurance, Health; Male; Mass Screening; Pediatrics; Physical Examination; Referral and Consultation; Retrospective Studies; Rural Population; Sensitivity and Specificity; Social Class; Sports; Students; United States; Young Adult; United States; American Heart Association; ACC; ICD-9; HCM; International Classification of Diseases, Ninth Revision; PPE; Electrocardiogram; ECG; Hypertrophic cardiomyopathy; Preparticipation history and examination; American College of Cardiology; AHA
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2015.06.011

Objective To retrospectively characterize electrocardiogram (ECG) use among preparticipation history and examinations (PPEs). Study design Using the 2005 to 2010 MarketScan insurance database, we identified subjects aged 5-21 years with either a PPE with an ECG or a PPE alone, excluding those with known cardiac diagnoses. We described cardiology referrals and subspecialty testing within 180 days and cardiac diagnoses within 1 year of the PPE, and the costs of testing in each group. Results From 2005-2009, 503 304 PPEs occurred in 419 456 subjects, of which 8621 (2%) included an ECG. ECG use increased from 12-20 per 1000 PPEs from 2005-2009. Females, lower socioeconomic status, and rural settings were associated with fewer ECGs. Thirteen percent of PPEs with ECG and 0.5% of PPEs alone led to a cardiology referral. After PPEs with ECG, cardiac disease was identified in 18% (2% sports-limiting); after PPEs alone, cardiac disease was identified in 0.5% (0.03% sports-limiting). The PPE had a sensitivity of 44% and a specificity of 98.6% of identifying cardiac disease. The total reimbursement cost of PPEs plus testing was $80 396 464 ($160 per PPE). Conclusions These real-world data demonstrate that community providers selectively use the ECG as part of the PPE with a high rate of identification of cardiac disease. Mass ECG screening would need to be more efficient at identifying disease than this selective approach.