title: Impact of the American Heart Association scientific statement on screening electrocardiograms and stimulant medications.
abstract: OBJECTIVE
  To evaluate the impact of the American Heart Association (AHA) scientific statement regarding electrocardiograms (ECGs) and stimulant medications on the practice of community pediatricians.
  
  
  METHODS
  Retrospective evaluation and survey analysis.
  
  
  METHODS
  Academic tertiary care center.
  
  
  METHODS
  Patients with ECGs referred to our institution by pediatricians with an indication of stimulant medication screening in the year after the AHA statement.
  
  
  METHODS
  We compared the ECG ordering practices of community pediatricians and the outcomes of further evaluation and estimated the associated cost before and after the AHA scientific statement.
  
  
  METHODS
  Abnormal ECG findings, further workup, and change in clinical practice.
  
  
  RESULTS
  In the year after publication of the 2008 AHA scientific statement, 372 ECGs were ordered with an indication of stimulant medication screening. Before publication of this statement, a mean (SD) of 6.9 (3.2) ECGs per month were referred for this indication. Despite continuing controversy, this number increased 4-fold to 31.2 (9.5) ECGs per month in the subsequent year. Twenty-four ECGs (6.4%) had abnormal findings. Eighteen patients were referred for further evaluation, and, at last follow-up, none had been found to have definitive disease. Six of 24 patients with abnormal ECG findings (25.0%) had a perceived significant delay in therapy because of the process. In responding pediatricians, 34.6% reported that the scientific statement had clearly affected their practice.
  
  
  CONCLUSIONS
  The clinical practice of community pediatricians in regard to screening ECGs and stimulant medications has been affected by the recent AHA scientific statement. The yield of performing ECGs with an indication of stimulant medication screening is very low.
authors.affiliation: Lillie Frank Abercrombie Section of Pediatric Cardiology, Department of Cardiology, Texas Children's Hospital, 6621 Fannin, Houston, TX 77030, USA.
authors.forename: Patricia Elizabeth
authors.initials: PE
authors.lastname: Thomas
authors.forename: Waldemar F
authors.initials: WF
authors.lastname: Carlo
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Decker
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Cannon
authors.forename: Naomi J
authors.initials: NJ
authors.lastname: Kertesz
authors.forename: Richard A
authors.initials: RA
authors.lastname: Friedman
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000572:American Heart Association; D001145:Arrhythmias, Cardiac / Q000139:chemically induced* / Q000175:diagnosis* / Q000517:prevention & control; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D002648:Child; D004562:Electrocardiography / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening; D010821:Physicians, Family; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013781:Texas; D014481:United States
chemical_list: D000697:Central Nervous System Stimulants