title: Accuracy of interpretation of preparticipation screening electrocardiograms.
abstract: OBJECTIVE
  To evaluate the accuracy of pediatric cardiologists' interpretations of electrocardiograms (ECGs).
  
  
  METHODS
  A series of 18 ECGs that represented conditions causing pediatric sudden cardiac death or normal hearts were interpreted by 53 members of the Western Society of Pediatric Cardiology. Gold-standard diagnoses and recommendations were determined by 2 electrophysiologists (100% concordance).
  
  
  RESULTS
  The average number of correct ECG interpretations per respondent was 12.4 ± 2.2 (69%, range 34%-98%). Respondents achieved a sensitivity of 68% and a specificity of 70% for recognition of any abnormality. The false-positive and false-negative rates were 30% and 32%, respectively. Based on actual ECG diagnosis, sports participation was accurately permitted in 74% of cases and accurately restricted in 81% of cases. Respondents gave correct sports guidance most commonly in cases of long QT syndrome and myocarditis (98% and 90%, respectively) and least commonly in cases of hypertrophic cardiomyopathy, Wolff-Parkinson-White syndrome, and pulmonary hypertension (80%, 64%, and 38%, respectively). Respondents ordered more follow-up tests than did experts.
  
  
  CONCLUSIONS
  Preparticipation screening ECGs are difficult to interpret. Mistakes in ECG interpretation could lead to high rates of inappropriate sports guidance. A consequence of diagnostic error is overuse of ancillary diagnostic tests.
authors.affiliation: Department of Pediatrics, Stanford University, Stanford, CA, USA.
authors.forename: Allison C
authors.initials: AC
authors.lastname: Hill
authors.forename: Christina Y
authors.initials: CY
authors.lastname: Miyake
authors.forename: Stafford
authors.initials: S
authors.lastname: Grady
authors.forename: Anne M
authors.initials: AM
authors.lastname: Dubin
mesh_terms: D002983:Clinical Competence; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D004452:Echocardiography; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005188:False Negative Reactions; D005189:False Positive Reactions; D006331:Heart Diseases / Q000175:diagnosis; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis; D008403:Mass Screening; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D013177:Sports; D011795:Surveys and Questionnaires