title: Cardiac screening prior to stimulant treatment of ADHD: a survey of US-based pediatricians.
abstract: OBJECTIVE
  To determine pediatricians' attitudes, barriers, and practices regarding cardiac screening before initiating treatment with stimulants for attention-deficit/hyperactivity disorder.
  
  
  METHODS
  A survey of 1600 randomly selected, practicing US pediatricians with American Academy of Pediatrics membership was conducted. Multivariate models were created for 3 screening practices: (1) performing an in-depth cardiac history and physical (H & P) examination, (2) discussing potential stimulant-related cardiac risks, and (3) ordering an electrocardiogram (ECG).
  
  
  RESULTS
  Of 817 respondents (51%), 525 (64%) met eligibility criteria. Regarding attitudes, pediatricians agreed that both the risk for sudden cardiac death (SCD) (24%) and legal liability (30%) were sufficiently high to warrant cardiac assessment; 75% agreed that physicians were responsible for informing families about SCD risk. When identifying cardiac disorders, few (18%) recognized performing an in-depth cardiac H & P as a barrier; in contrast, 71% recognized interpreting a pediatric ECG as a barrier. When asked about cardiac screening practices before initiating stimulant treatment for a recent patient, 93% completed a routine H & P, 48% completed an in-depth cardiac H & P, and 15% ordered an ECG. Almost half (46%) reported discussing stimulant-related cardiac risks. Multivariate modeling indicated that ≥1 of these screening practices were associated with physicians' attitudes about SCD risk, legal liability, their responsibility to inform about risk, their ability to perform an in-depth cardiac H & P, and family concerns about risk.
  
  
  CONCLUSIONS
  Variable pediatrician attitudes and cardiac screening practices reflect the limited evidence base and conflicting guidelines regarding cardiac screening. Barriers to identifying cardiac disorders influence practice.
authors.affiliation: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA. lleslie@tuftsmedicalcenter.org
authors.forename: Laurel K
authors.initials: LK
authors.lastname: Leslie
authors.forename: Angie Mae
authors.initials: AM
authors.lastname: Rodday
authors.forename: Tully S
authors.initials: TS
authors.lastname: Saunders
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Cohen
authors.forename: John B
authors.initials: JB
authors.lastname: Wong
authors.forename: Susan K
authors.initials: SK
authors.lastname: Parsons
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D001291:Attitude of Health Personnel; D002423:Cause of Death; D000697:Central Nervous System Stimulants / Q000009:adverse effects* / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004562:Electrocardiography / Q000187:drug effects; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D016365:Liability, Legal; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D010372:Pediatrics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000706:statistics & numerical data; D014481:United States; D014600:Utilization Review
chemical_list: D000697:Central Nervous System Stimulants