Electrocardiogram in Preparticipation Athletic Evaluations among Insured Youths

J Pediatr. 2015 Oct;167(4):804-809.e1. doi: 10.1016/j.jpeds.2015.06.011. Epub 2015 Jul 3.


Objective: To retrospectively characterize electrocardiogram (ECG) use among preparticipation history and examinations (PPEs).

Study design: Using the 2005 to 2010 MarketScan insurance database, we identified subjects aged 5-21 years with either a PPE with an ECG or a PPE alone, excluding those with known cardiac diagnoses. We described cardiology referrals and subspecialty testing within 180 days and cardiac diagnoses within 1 year of the PPE, and the costs of testing in each group.

Results: From 2005-2009, 503 304 PPEs occurred in 419 456 subjects, of which 8621 (2%) included an ECG. ECG use increased from 12-20 per 1000 PPEs from 2005-2009. Females, lower socioeconomic status, and rural settings were associated with fewer ECGs. Thirteen percent of PPEs with ECG and 0.5% of PPEs alone led to a cardiology referral. After PPEs with ECG, cardiac disease was identified in 18% (2% sports-limiting); after PPEs alone, cardiac disease was identified in 0.5% (0.03% sports-limiting). The PPE had a sensitivity of 44% and a specificity of 98.6% of identifying cardiac disease. The total reimbursement cost of PPEs plus testing was $80 396 464 ($160 per PPE).

Conclusions: These real-world data demonstrate that community providers selectively use the ECG as part of the PPE with a high rate of identification of cardiac disease. Mass ECG screening would need to be more efficient at identifying disease than this selective approach.

MeSH terms

  • Adolescent
  • Adult
  • Cardiology / methods*
  • Cardiology / standards
  • Child
  • Child, Preschool
  • Electrocardiography / statistics & numerical data*
  • False Positive Reactions
  • Female
  • Heart Diseases / diagnosis*
  • Humans
  • Insurance, Health
  • Male
  • Mass Screening
  • Physical Examination
  • Referral and Consultation
  • Retrospective Studies
  • Rural Population
  • Sensitivity and Specificity
  • Social Class
  • Sports*
  • Students
  • United States
  • Young Adult