title: Electrocardiogram screening for disorders that cause sudden cardiac death in asymptomatic children: a meta-analysis.
abstract: OBJECTIVE
  Pediatric sudden cardiac death (SCD) occurs in an estimated 0.8 to 6.2 per 100 000 children annually. Screening for cardiac disorders causing SCD in asymptomatic children has public appeal because of its apparent potential to avert tragedy; however, performance of the electrocardiogram (ECG) as a screening tool is unknown. We estimated (1) phenotypic (ECG- or echocardiogram [ECHO]-based) prevalence of selected pediatric disorders associated with SCD, and (2) sensitivity, specificity, and predictive value of ECG, alone or with ECHO.
  
  
  METHODS
  We systematically reviewed literature on hypertrophic cardiomyopathy (HCM), long QT syndrome (LQTS), and Wolff-Parkinson-White syndrome, the 3 most common disorders associated with SCD and detectable by ECG.
  
  
  RESULTS
  We identified and screened 6954 abstracts, yielding 396 articles, and extracted data from 30. Summary phenotypic prevalences per 100 000 asymptomatic children were 45 (95% confidence interval [CI]: 10-79) for HCM, 7 (95% CI: 0-14) for LQTS, and 136 (95% CI: 55-218) for Wolff-Parkinson-White. The areas under the receiver operating characteristic curves for ECG were 0.91 for detecting HCM and 0.92 for LQTS. The negative predictive value of detecting either HCM or LQTS by using ECG was high; however, the positive predictive value varied by different sensitivity and specificity cut-points and the true prevalence of the conditions.
  
  
  CONCLUSIONS
  Results provide an evidence base for evaluating pediatric screening for these disorders. ECG, alone or with ECHO, was a sensitive test for mass screening and negative predictive value was high, but positive predictive value and false-positive rates varied.
authors.affiliation: Tufts Medical Center, Boston, Massachusetts, USA.
authors.forename: Angie Mae
authors.initials: AM
authors.lastname: Rodday
authors.forename: John K
authors.initials: JK
authors.lastname: Triedman
authors.forename: Mark E
authors.initials: ME
authors.lastname: Alexander
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Cohen
authors.forename: Stanley
authors.initials: S
authors.lastname: Ip
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
authors.forename: Susan K
authors.initials: SK
authors.lastname: Parsons
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Trikalinos
authors.forename: John B
authors.initials: JB
authors.lastname: Wong
authors.forename: Laurel K
authors.initials: LK
authors.lastname: Leslie
mesh_terms: D002648:Child; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology*; D004562:Electrocardiography; D014943:Global Health; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000379:methods*; D015995:Prevalence