Abstract 18613: Improved Adolescent Pre-Athletic Screening Sensitivity and Specificity with Seattle Criteria-interpreted ECGs
Introduction: Sudden cardiac arrest (SCA) is a rare but devastating cause of death in children and young adults. While electrocardiogram (ECG) can detect many causes of SCA, ECG are not routinely included in pre-athletic screening (PAS) protocols in the United States due, in part, to a high rate of false positive (FP) interpretations in adolescents. Recently, an expert consensus panel developed refined ECG criteria (Seattle Criteria) to improve the specificity for ECG identification of cardiac conditions associated with SCA.
Methods: We compared standard ECG criteria with Seattle Criteria in the interpretation of ECGs obtained as part of a youth community SCA screening program. Students completed an AHA-endorsed PAS that included a cardiac specific history and physical exam. A 12 lead ECG was obtained and interpreted by a board certified pediatric cardiologist (PDC). Students found to have a positive PAS screen or abnormal standard ECG completed additional work up with a PDC. All ECGs referred for additional evaluation were interpreted by a PDC using Seattle Criteria in a blinded manner.
Results: A total of 1,034 students 11-13 years of age were evaluated. No referrals for additional testing were made based on PAS history alone. There were 72 (7%) ECG abnormalities identified by standard PDC interpretation, while Seattle Criteria identified 21 (2%) ECGs that met criteria for further testing. Formal cardiology evaluation confirmed 4 students at risk for SCA (0.38%); LQTS (n=2), WPW (n=1) and PHTN (n=1); incidental findings isolated RBBB (n=1), MVP (n=1) and PFO (n=1). All students at risk for SCA were identified by both standard pediatric ECG and Seattle Criteria interpretations. Specificity for standard ECG was 93% and for Seattle criteria was 98%.
Conclusions: This study demonstrates that inclusion of ECGs in PAS improves the sensitivity for identifying middle school students at risk for SCA compared to history and exam alone. While standard pediatric ECG interpretation yields a 6.5% incidence of FP, application of Seattle Criteria reduces the incidence of FP ECGs in this age group to 1.6% with no adverse effect on sensitivity. This data supports utilizing Seattle Criteria interpretation for community SCA screening programs that include ECG.
Author Disclosures: J.N. Colombo: None. R. Samson: None. S. Valdes: None. D. Sisk: None. S. Klewer: None.
- © 2014 by American Heart Association, Inc.