title: Cost and yield of adding electrocardiography to history and physical in screening Division I intercollegiate athletes: a 5-year experience.
abstract: BACKGROUND
  Electrocardiographic screening of intercollegiate athletes is controversial because the costs and yield are not well defined. Both the American Heart Association (AHA) and the European Society of Cardiology (ESC) have different criteria for screening, partly because the populations being screened are different.
  
  
  OBJECTIVE
  The purpose of this study was to determine the cost and yield of a 5-year ECG screening program at a United States Division I college.
  
  
  METHODS
  At the University of Virginia, all 1,473 competitive athletes over the course of 5 years were screened with history and physical and with ECGs using ESC guidelines with follow-up testing as dictated by clinical symptoms and ECG findings.
  
  
  RESULTS
  History and physical alone uncovered five significant cardiac abnormalities. ECGs were abnormal in 275 (19%), resulting in 359 additional tests. Additional testing confirmed eight significant cardiac abnormalities that were not found by history and physical: 1 bicuspid aortic valve, 4 rapidly conducting accessory pathways, 1 long QT patient, 1 with frequent premature ventricular contractions and low ejection fraction, and 1 with frequent premature ventricular contractions but normal ejection fraction. No cases of hypertrophic cardiomyopathy were found. Total cost of the program was US $894,870. Cost of history and physical screening alone was $343,725 or $68,745 per finding. The marginal cost of adding ECG screening, including resulting tests and procedures. was US$551,145 or US$68,893 per additional finding.
  
  
  CONCLUSIONS
  ECG screening of U.S. college athletes can uncover significant cardiac pathology not discovered by history and physical alone. Although ECG screening also results in many false positives resulting in additional tests, the overall cost per diagnosis of adding ECG screening is similar to that of history and physical screening alone.
authors.affiliation: Department of Internal Medicine, University of Virginia, Charlottesville, Virginia 22908, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Malhotra
authors.forename: J Jason
authors.initials: JJ
authors.lastname: West
authors.forename: John
authors.initials: J
authors.lastname: Dent
authors.forename: Max
authors.initials: M
authors.lastname: Luna
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Kramer
authors.forename: J Paul
authors.initials: JP
authors.lastname: Mounsey
authors.forename: Robert
authors.initials: R
authors.lastname: Battle
authors.forename: Ethan
authors.initials: E
authors.lastname: Saliba
authors.forename: Benjamin
authors.initials: B
authors.lastname: Rose
authors.forename: Dilaawar
authors.initials: D
authors.lastname: Mistry
authors.forename: John
authors.initials: J
authors.lastname: MacKnight
authors.forename: John P
authors.initials: JP
authors.lastname: DiMarco
authors.forename: Srijoy
authors.initials: S
authors.lastname: Mahapatra
mesh_terms: D000328:Adult; D056352:Athletes; D004562:Electrocardiography / Q000191:economics*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008487:Medical History Taking; D010808:Physical Examination