Electrocardiographic screening in children with attention-deficit hyperactivity disorder

Area of Science:

• Pediatric Cardiology
• Clinical Effectiveness Research

Background:

• Stimulant medications for attention-deficit hyperactivity disorder (ADHD) have prompted suggestions for electrocardiographic screening.
• The efficacy and cost-effectiveness of this screening strategy in children remain unexamined.

Purpose of the Study:

• To determine the utility and cost of electrocardiographic screening for identifying cardiac disease in children with ADHD.

Main Methods:

• A retrospective review of electrocardiograms from 1,470 children (<21 years) with ADHD was conducted.
• Abnormal screening results prompted further cardiac evaluation, including echocardiograms, stress tests, and Holter monitors.
• Costs associated with screening and subsequent testing were analyzed.

Main Results:

• Electrocardiograms were abnormal in 8.1% of subjects, leading to further testing.
• Cardiac disease was identified in 5 subjects (0.3% of the cohort), with a positive predictive value of 4.2%.
• The mean cost per child screened was $58, and the cost per true-positive case was $17,162.

Conclusions:

• Electrocardiographic screening can detect asymptomatic cardiac conditions in children with ADHD.
• The low positive predictive value and significant cost warrant further investigation into the role of screening in ADHD management.