Performance of the Lausanne questionnaire and the 2010 European Society of Cardiology criteria for ECG interpretation in athletes.
BACKGROUND
In recent years various proposals and subsequent changes have been made to improve pre-participation screening (PPS) methods. This study examines the Lausanne questionnaire and the old and new ESC criteria for a positive electrocardiogram (ECG) in athletes.


METHODS
Retrospective cohort study.


METHODS
All consecutive students undergoing a PPS between January and July 2011 were included. The screening consisted of the Lausanne questionnaire, a physical examination, and a 12-lead ECG.


RESULTS
A total of 561 students were screened. A total of 310 students (55%) answered positively to one or more of the Lausanne questions and 49 (9%) of these abnormalities were assessed as medically relevant. Physical examination was abnormal in nine (1.6%) students. In total, 120 (21%) ECGs were found positive following the old criteria. According to the new criteria, 68 (12%) ECGs were found positive. Four (already known) congenital cardiac disorders and four new diagnoses were found. When using the new ECG criteria, two out of four new cardiovascular diagnoses would have been missed.


CONCLUSIONS
The use of the Lausanne questionnaire provides many irrelevant findings causing unnecessary positive screening outcomes. With the new ESC criteria for a positive 12-lead ECG in athletes, the number of false-positive screenings greatly decrease: however, at the cost of an increase in the number of false-negatives. To reach a conclusive judgment on the cost:benefit ratio of PPS, it is necessary to have a validated discriminating questionnaire, specific medical knowledge of PPS and clear definitions of a normal and abnormal 12-lead ECG in athletes.
Isala Klinieken, Zwolle, The Netherlands j.a.snoek@isala.nl.
Johan A
JA
Snoek
Isala Klinieken, Zwolle, The Netherlands.
Jesse K
JK
Jongman
Isala Klinieken, Zwolle, The Netherlands.
Tom
T
Brandon
Isala Klinieken, Zwolle, The Netherlands.
Sietske
S
van Berkel
Isala Klinieken, Zwolle, The Netherlands.
Arnoud W J
AW
van't Hof
D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D056352:Athletes; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D004562:Electrocardiography; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
ECG; pre-participation screening; sudden cardiac death