Cardiac preparticipation screening for the young athlete: why the routine use of ECG is not necessary

The addition of an electrocardiogram (ECG) to the current United States athlete preparticipation physical evaluation (PPE) as a screening tool has dominated the PPE discussion over the past decade despite the lack of demonstrable outcomes data supporting the routine use of the diagnostic study for reduction of sudden cardiac death (SCD). A good screening test should influence a disease or health outcome that has a significant impact on public health and the population screened must have a high prevalence of the disease to justify the screening intervention. While SCD is publicly remarkable and like any death, tragic, the prevalence of SCD in young athletes is very low and the potential for false positive results is high. While ECG screening appears to have made an impact on SCD in Italian athletes, the strategy has made no impact on Israeli athletes, and the overall impact of ECG screening on American athletes is unclear. Until outcomes studies show substantial SCD reduction benefit, the addition of routine ECG PPE screening in young athletes should not be instituted.