Preparticipation electrocardiogram screening in a Gulf Coast community: A prospective study

Sudden cardiac death in young athletes is a devastating event unparalleled in the sports community. The debate over electrocardiogram (ECG) screening of young athletes has been ongoing for many years and recommendations vary widely.

We prospectively studied students in coastal Alabama to compare the detection rate of life-threatening cardiac pathology using a 12-lead ECG vs a preparticipation questionnaire.

A total of 2604 students in coastal Alabama aged 5-22 years (median age, 15 years) were included between 2014 and 2019. They completed the American Heart Association (AHA) 14-point preparticipation questionnaire and underwent a 12-lead ECG.

Of participants answering the questionnaire, 60.2% were men, 81.4% were White, and 10.7% were Black. There were 306 (11.9%) of 2565 students who reported symptoms that would have triggered referral to a cardiologist, with the most common (88.2%) being chest pain, shortness of breath, and palpitations. Of 2604 ECGs, 86 (3.3%) were abnormal, with the most frequent findings (54.7%) being T wave inversions and pathologic Q waves. The AHA screening questionnaire had a sensitivity of 33.0% and specificity of 78.7%, while the ECG screening had 100% sensitivity and 97.0% specificity. Three students (0.1%) were found to have conditions associated with sudden cardiac arrest which were detected by ECG, although only 1 of these students reported symptoms on the questionnaire which would have prompted a referral.

The 14-point AHA questionnaire raised suspicion for unnecessary referrals while missing 66.0% of the life-threatening pathologies detected with ECG.