Variability in interpretation of the electrocardiogram in young athletes: an unrecognized obstacle for electrocardiogram-based screening protocols

Berte, Benjamin; Duytschaever, Mattias; Elices, Juliana; Kataria, Vikas; Timmers, Liesbeth; Heuverswyn, Frédéric Van; Stroobandt, Roland X.; Neve, Jan De; Watteyne, Karel; Vandensteen, Elke; Vandekerckhove, Yves; Tavernier, René

doi:10.1093/europace/euu385

Cited by 23 publications

(13 citation statements)

References 13 publications

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“…Berte et al 14 suggested there is a discrepancy between ECG interpretation accuracy between sports medicine physicians and cardiologists. Among cardiologists, Dhutia et al 15 found that both ECG interpretation accuracy and the choice of further investigations were heavily physician dependent, with those experienced in athlete screening performing better than their inexperienced colleagues.…”

Section: Discussionmentioning

confidence: 99%

Performance of the BMJ learning training modules for ECG interpretation in athletes

Riding

Drezner

2018

Heart

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To assess the accuracy of interpreting the athlete's ECG both pre and post a series of online training modules among a range of healthcare professionals. 10 512 healthcare professionals from 138 different nations commenced the online course. These were primarily doctors (43%), nurses (18.4%) and other healthcare professionals (3.9%). The users came from 102 different specialities, with General Practice/Family Medicine (24.5%), Cardiology (10.6%), Emergency Medicine (8.7%) and Sports Medicine (6.6%) predominating. Among the 2023 users who completed both the pre-course and post-course test, there was an overall improvement of 15.3% (95% CI 13.9% to 16.6%; p<0.001). 930 completed all four other modules, and these users fared significantly better (18.7% increase; 95% CI 17.3 to 20.0) than those completing no additional modules (11.7% increase; 95% CI 3.3 to 17.7, p=0.036). Demographic analysis showed that while the starting pre-test scores varied significantly between profession/specialty groups (57.8%-82.6%), post-test scores were largely consistent (80.8%-84.6%). Although users showed the most improvement when interpreting primary electrical diseases (12.4% increase), it was also an area of notable weakness compared with the modules of normal training-related findings and cardiomyopathies. With the evolving criteria for ECG interpretation eliciting ever improving levels of specificity and sensitivity in the detection of conditions associated with sudden cardiac death among athletes, training is required to ensure the infrastructure and personnel is in place to uphold these standards. The BMJ Learning course presented is a valuable first step and demonstrates that such an online tool can be effective in aiding ECG interpretation among healthcare professionals globally.

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Section: Discussionmentioning

confidence: 99%

Performance of the BMJ learning training modules for ECG interpretation in athletes

Riding

Drezner

2018

Heart

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“…As above, while sensitivity and specificity of the ECG are imperfect, both are likely better with the ECG. Quality control is another issue, but while there are difficulties with quality control both with obtaining the ECG, and with physician interpretation,30 H&P performance also falls short 31. Initiatives to train physicians in the preparticipation H&P, such as now required in some US states, are an important endeavour.…”

Section: Preparticipation Cardiac Screening In Athletesmentioning

confidence: 99%

ECG screening in athletes: differing views from two sides of the Atlantic

Lampert¹

2017

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“…Although cardiovascular screening has been adopted as public policy and met with widespread acceptance in some countries, 49,88,129 practical concerns have limited enthusiasm for mandated screening in the US and elsewhere. 130 Chief among these are 1) the impact of false-positive findings, which include unnecessary work-up, proscription from sport or other desired, healthful or necessary activity, and possible creation of psychological harms, 115,116 2) the effect of inaccuracy in diagnosis to discount the potential value of cardiovascular screening in actual use [131][132][133] , and 3) the willingness of patients with positive screening tests to pursue further diagnosis and management. 114 Effective yield of screening tests can be increased by limiting testing to relatives of disease probands.…”

Section: Identification Of Young Patients At Risk For Scd Prodromal Smentioning

confidence: 99%

Sudden cardiac death in the young

2017

Progress in Pediatric Cardiology

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Although the occurrence of sudden cardiac death (SCD) in a young person is a rare event, it is traumatic and often widely publicized. In recent years, SCD in this population has been increasingly seen as a public health and safety issue. This review presents current knowledge relevant to the epidemiology of SCD and to strategies for prevention, resuscitation and identification of those at greatest risk. Areas of active research and controversy include the development of best practices in screening, risk stratification approaches and post-mortem evaluation, and identification of modifiable barriers to providing better outcomes after resuscitation of young SCD victims. Institution of a national registry of SCD in the young will provide data that will help to answer these questions.

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Variability in interpretation of the electrocardiogram in young athletes: an unrecognized obstacle for electrocardiogram-based screening protocols

Abstract: Seattle criteria reduced the number of abnormal ECGs in athletes and increased agreement in classification. However, variability in ECG interpretation by cardiologists and sport physicians remains high and is a limitation for ECG-based screening programs.

Cited by 23 publications

References 13 publications

Performance of the BMJ learning training modules for ECG interpretation in athletes

Performance of the BMJ learning training modules for ECG interpretation in athletes

ECG screening in athletes: differing views from two sides of the Atlantic

Sudden cardiac death in the young

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