Key result
The International ECG screening criteria demonstrated a lower false-positive rate compared with the Seattle criteria (OR 0.58; P=0.02) for preparticipation screening in NCAA Division I athletes.
Why the study?
The study was conducted to analyze 5 years of preparticipation ECG screening in NCAA Division I athletes and compare screening abnormality and false-positive rates among three ECG criteria.
Does the International ECG criteria reduce false-positive rates compared to the Seattle and Refined criteria in collegiate athletes undergoing preparticipation screening?
Observational (n=1,686)
No
Does the International ECG criteria reduce false-positive rates compared to the Seattle and Refined criteria in collegiate athletes undergoing preparticipation screening?
Odds Ratio: 0.58
Absolute Event Rate: 1.8% vs 3%
p-value: p=0.02
The International ECG criteria provide the lowest false-positive rate for preparticipation cardiovascular screening in collegiate athletes compared to the Seattle and Refined criteria.
International criteria showed lowest false-positive ECG rate in NCAA athletes; supports preferential use but leaves open need for prospective confirmation before practice change.
OBJECTIVES: To: (1) analyze the results of 5 years of preparticipation cardiac screening including 12-lead electrocardiogram (ECG) of National Collegiate Athletic Association (NCAA) Division I athletes; and (2) assess the rates of ECG screening abnormalities and false-positive rates among 3 ECG screening criteria. DESIGN: Retrospective chart review. SETTING: National Collegiate Athletic Association Division I University. PARTICIPANTS: One thousand six hundred eighty-six first-year athletes presenting for their preparticipation examination including 12-lead resting ECG. INTERVENTIONS: At the completion of the study period, all ECGs were retrospectively reviewed using the Seattle, Refined, and International Criteria. MAIN OUTCOME MEASURES: (1) Prevalence of pathologic cardiac conditions identified by screening; and (2) number of ECG screening abnormalities by criteria. RESULTS: Three athletes (0.2%) were found to have conditions that are associated with sudden cardiac death. Retrospective review of ECGs using Seattle, Refined, and International criteria revealed an abnormal ECG rate of 3.0%, 2.1%, and 1.8%, respectively. International criteria [odds ratios (OR), 0.58; P = 0.02] demonstrated a lower false-positive rate compared with the Seattle criteria. There was no significant difference in false-positive rates between the Seattle and Refined (OR, 0.68; P = 0.09) or the International and Refined criteria (OR, 0.85; P = 0.5). CONCLUSIONS: There was a low rate of significant cardiac pathology in this population, and no athletes were permanently restricted from play as a result of screening. Our results suggest that the International criteria have the lowest false-positive rate of athlete-specific ECG criteria, and thus, it is the preferred method for preparticipation ECG screening in NCAA athletes.
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Conway et al. (2022) conducted an observational in Preparticipation cardiac screening (n=1,686). International ECG screening criteria vs. Seattle criteria was evaluated on False-positive rate of ECG screening abnormalities (OR 0.58, p=0.02). The International ECG screening criteria demonstrated a lower false-positive rate compared with the Seattle criteria (OR 0.58; P=0.02) for preparticipation screening in NCAA Division I athletes.
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