Key result
ECG screening detects ~3.5 times more cardiovascular conditions than H&P alone with fewer false positives.
Why the study?
To evaluate pre-participation cardiovascular screening outcomes in NCAA athletes and quantify the added value of history and physical examination when combined with a screening ECG.
Does screening ECG improve the detection of cardiovascular conditions associated with serious morbidity or sudden cardiac arrest/death in NCAA athletes compared to history and physical exam alone?
Does screening ECG improve the detection of cardiovascular conditions associated with serious morbidity or sudden cardiac arrest/death in NCAA athletes compared to history and physical exam alone?
In NCAA athletes, pre-participation ECG screening significantly increases the detection of high-risk cardiovascular conditions and yields fewer false positives compared to history and physical examination alone.
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May warrant adding ECG to NCAA preparticipation screening; reinforces consensus on superiority versus H&P alone.
Objective To evaluate the outcomes of pre-participation cardiovascular screening among National Collegiate Athletic Association (NCAA) athletes and quantify the added value of history and physical exam (H&P) when combined with a screening ECG. Design Systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources MEDLINE (1946–present), EMBASE (1947–present), PubMed (1966–present) and Cochrane Library (1991–present). Eligibility criteria for selecting studies Peer-reviewed research articles published in English reporting original findings on pre-participation cardiovascular screening outcomes in NCAA athletes. Results 18 studies, representing 27 891 NCAA athletes (44.2% female), were included. A total of 66 (0.24%) athletes were diagnosed with a cardiovascular condition associated with serious morbidity or sudden cardiac arrest/death (SCA/D). Wolff-Parkinson-White was the most common diagnosis (n=39, 59.1%), followed by hypertrophic cardiomyopathy (n=11, 16.7%). Among the eight studies (16 609 athletes) for which the screening performance of ECG and H&P could be extracted separately, ECG screening resulted in a 3.5-fold higher detection rate of true positive cases (number needed to screen (NNS) =475) compared with H&P alone (NNS=1661). The false positive rate for H&P was 17% versus 5% for ECG (p<0.001). The added value of H&P in athletes with a negative ECG was low (NNS=3003). Conclusion ECG screening significantly increases the detection of conditions associated with serious morbidity or SCA/D compared with H&P alone, with H&P providing minimal added value in athletes with a normal ECG. Our findings support the utility of ECG in preparticipation screening for NCAA athletes. PROSPERO registration number CRD42020188308.
Conway et al. (2026) studied this question. ECG screening detected 3.5 times more cardiovascular conditions than history and physical exam alone in NCAA athletes, with false positives of 5% versus 17%, respectively.
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