Document Detail

Is there evidence for mandating electrocardiogram as part of the pre-participation examination?
MedLine Citation:
PMID:  21200165     Owner:  NLM     Status:  MEDLINE    
The risk of sudden cardiac death may be increased up to 2.8 times in competitive athletes compared with nonathletes. The majority of sudden cardiac death cases are caused by an underlying abnormality that potentially may be identified on cardiovascular screening, depending on the specific abnormality and the content of the cardiovascular screening applied. Indeed, today, cardiac screening is universally recommended by the cardiac societies [European Society of Cardiology (ESC) and American Heart Association (AHA)] and required by the sporting bodies [Fédération Internationale de Football Association (FIFA) and Union of European Football Associations (UEFA)]. Pre-participation examination is by consensus understood to include personal history and physical examination; controversy exists regarding the usefulness and appropriateness of screening using resting 12-lead electrocardiogram (ECG), with an apparent transatlantic difference. The ESC recommends screening consisting of personal history, physical examination, and 12-lead resting ECG, whereas recommendations from the AHA includes only personal history and physical examination. There is firm scientific ground to state that the sensitivity of screening with ECG is vastly superior to, and the cost-effectiveness significantly better than, screening without ECG. Cardiac screening of elite athletes with personal history, physical examination, and ECG is cost-effective also in comparison with other well-accepted procedures of modern health care, such as dialysis and implantable cardiac defibrillators. Newly published recommendations for the interpretation of the ECG in athletes (ESC) and future studies on ECGs in athletes of different ethnicity, gender, and age may further increase the specificity of ECG in cardiac screening, refining the screening procedure and lowering the costs for additional follow-up testing. Cardiac screening without ECG is not cost-effective and may be only marginally better than no screening at all and at a considerable higher cost. The difficulties in feasibility and liability issues for recommending ECGs in some countries need to be acknowledged but must be dealt with within those countries/systems. On ethical grounds, the reasons (logistical, legal, economic) for not screening individual athletes should be clearly stated. Alas, the current evidence, as presented here, suggests that the ECG should be mandatory in pre-participation screening of athletes.
Mats Borjesson; Mikael Dellborg
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine     Volume:  21     ISSN:  1536-3724     ISO Abbreviation:  Clin J Sport Med     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-04     Completed Date:  2011-04-13     Revised Date:  2011-10-12    
Medline Journal Info:
Nlm Unique ID:  9103300     Medline TA:  Clin J Sport Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  13-7     Citation Subset:  IM    
Department of Acute and Emergency Medicine, Sahlgrenska University Hospital, Ostra, Sahgrenska Academy, Goteborg, Sweden.
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MeSH Terms
Cardiovascular Diseases / diagnosis
Death, Sudden, Cardiac / prevention & control*
Electrocardiography / economics,  methods*
Evidence-Based Medicine*
Feasibility Studies
Mandatory Testing / economics,  methods*
Medical History Taking
Physical Examination / economics,  methods*
Sensitivity and Specificity
Sports Medicine
Comment In:
Clin J Sport Med. 2011 Sep;21(5):460; author reply 460   [PMID:  21892020 ]
Clin J Sport Med. 2011 Sep;21(5):460   [PMID:  21892019 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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