Preparticipation electrocardiogram screening in a Gulf Coast community: A prospective study

Background: Sudden cardiac death in young athletes is a devastating event unparalleled in the sports community. The debate over electrocardiogram (ECG) screening of young athletes has been ongoing for many years and recommendations vary widely. Objective: We prospectively studied students in coastal Alabama to compare the detection rate of life-threatening cardiac pathology using a 12-lead ECG vs a preparticipation questionnaire. Methods: A total of 2604 students in coastal Alabama aged 5-22 years (median age, 15 years) were included between 2014 and 2019. They completed the American Heart Association (AHA) 14-point preparticipation questionnaire and underwent a 12-lead ECG. Results: Of participants answering the questionnaire, 60.2% were men, 81.4% were White, and 10.7% were Black. There were 306 (11.9%) of 2565 students who reported symptoms that would have triggered referral to a cardiologist, with the most common (88.2%) being chest pain, shortness of breath, and palpitations. Of 2604 ECGs, 86 (3.3%) were abnormal, with the most frequent findings (54.7%) being T wave inversions and pathologic Q waves. The AHA screening questionnaire had a sensitivity of 33.0% and specificity of 78.7%, while the ECG screening had 100% sensitivity and 97.0% specificity. Three students (0.1%) were found to have conditions associated with sudden cardiac arrest which were detected by ECG, although only 1 of these students reported symptoms on the questionnaire which would have prompted a referral. Conclusion: The 14-point AHA questionnaire raised suspicion for unnecessary referrals while missing 66.0% of the life-threatening pathologies detected with ECG.