Electrocardiogram in Preparticipation Athletic Evaluations among Insured聽Youths

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• 作者：Kristin M. Burns ; MD¹ ; ^{kristin.burns@nih.gov" class="auth_mail" title="E-mail the corresponding author} ; William E. Encinosa ; PhD² ; Gail D. Pearson ; MD ; ScD¹ ; Jonathan R. Kaltman ; MD¹
• 关键词：ACC ; American College of Cardiology ; AHA ; American Heart Association ; ECG ; Electrocardiogram ; HCM ; Hypertrophic cardiomyopathy ; ICD-9 ; International Classification of Diseases ; Ninth Revision ; PPE ; Preparticipation history and examination
• 刊名：The Journal of Pediatrics
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：167
• 期：4
• 页码：804-809.e1
• 全文大小：538 K

文摘

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鈥?04 PPEs occurred in 419鈥?56 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鈥?96鈥?64 ($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.