Pediatric cardiologists may have difficulty interpreting ECGs for sports participation

Hill A. J Pediatr. 2011; doi: 10.1016/j.jpeds.2011.05.014

A group of pediatric cardiologists accurately permitted sports participation in less than 75% of cases after reviewing a series of electrocardiograms, according to recent results.

The aim of the study was to determine whether pediatric cardiologists are interpreting electrocardiograms (ECGs) accurately.

Fifty-three members of the Western Society of Pediatric Cardiology interpreted a series of 18 ECGs that represented normal hearts or conditions causing pediatric sudden cardiac death. Two electrophysiologists provided gold-standard diagnoses and recommendations.

The average number of correct interpretations per respondent was 12.4±2.2 (69%; range 34%-98%), according to the results. The sensitivity of respondents in recognizing abnormalities was 68%. The sensitivity was 70%. False positives occurred at a rate of 30%, while the false-negative rate was 32%. The responding physicians accurately permitted sports participation in 74% of cases, and restricted it accurately in 81% of cases, based on actual ECG diagnosis.

The most common correct sports guidance was in cases of long QT syndrome, at 98%, and in cases of myocarditis, at 90%. The least common correct sports guidance was given in cases of hypertrophic cardiomyopathy (80%), Wolff-Parkinson-White syndrome (64%) and pulmonary hypertension (38%).

More follow-up tests were ordered by respondents than by the electrophysiologists.

“Preparticipation screening ECGs are difficult to interpret,” the researchers wrote. “Mistakes in ECG interpretation could lead to high rates of inappropriate sports guidance. A consequence of diagnostic error is overuse of ancillary diagnostic tests.”

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