Accuracy of interpretation of preparticipation screening electrocardiograms

J Pediatr. 2011 Nov;159(5):783-8. doi: 10.1016/j.jpeds.2011.05.014. Epub 2011 Jul 14.


Objective: To evaluate the accuracy of pediatric cardiologists' interpretations of electrocardiograms (ECGs).

Study design: A series of 18 ECGs that represented conditions causing pediatric sudden cardiac death or normal hearts were interpreted by 53 members of the Western Society of Pediatric Cardiology. Gold-standard diagnoses and recommendations were determined by 2 electrophysiologists (100% concordance).

Results: The average number of correct ECG interpretations per respondent was 12.4 ± 2.2 (69%, range 34%-98%). Respondents achieved a sensitivity of 68% and a specificity of 70% for recognition of any abnormality. The false-positive and false-negative rates were 30% and 32%, respectively. Based on actual ECG diagnosis, sports participation was accurately permitted in 74% of cases and accurately restricted in 81% of cases. Respondents gave correct sports guidance most commonly in cases of long QT syndrome and myocarditis (98% and 90%, respectively) and least commonly in cases of hypertrophic cardiomyopathy, Wolff-Parkinson-White syndrome, and pulmonary hypertension (80%, 64%, and 38%, respectively). Respondents ordered more follow-up tests than did experts.

Conclusions: Preparticipation screening ECGs are difficult to interpret. Mistakes in ECG interpretation could lead to high rates of inappropriate sports guidance. A consequence of diagnostic error is overuse of ancillary diagnostic tests.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Clinical Competence*
  • Death, Sudden, Cardiac / prevention & control*
  • Diagnostic Errors / statistics & numerical data
  • Echocardiography
  • Electrocardiography*
  • Electrocardiography, Ambulatory
  • Exercise Test
  • False Negative Reactions
  • False Positive Reactions
  • Heart Diseases / diagnosis
  • Humans
  • Hypertension, Pulmonary / diagnosis
  • Mass Screening*
  • Practice Patterns, Physicians' / statistics & numerical data
  • Sports*
  • Surveys and Questionnaires