title: Reliability and validity of clinician ECG interpretation for athletes.
abstract: BACKGROUND
  Electrocardiogram (ECG) with preparticipation evaluation (PPE) for athletes remains controversial in the United States and diagnostic accuracy of clinician ECG interpretation is unclear. This study aimed to assess reliability and validity of clinician ECG interpretation using expert-validated ECGs according to the 2010 European Society of Cardiology (ESC) interpretation criteria.
  
  
  METHODS
  This is a blinded, prospective study of diagnostic accuracy of clinician ECG interpretation. Anonymized ECGs were validated for normal and abnormal patterns by blinded expert interpreters according to the ESC interpretation criteria from October 2011 through March 2012. Six pairs of clinician interpreters were recruited from relevant clinical specialties in an academic medical center in March 2012. Each clinician interpreted 85 ECGs according to the ESC interpretation guidelines. Cohen and Fleiss' kappa, sensitivity, and specificity were calculated within specialties and across primary care and cardiology specialty groups.
  
  
  RESULTS
  Experts interpreted 189 ECGs yielding a kappa of 0.63, demonstrating "substantial" inter-rater agreement. A total of 85 validated ECGs, including 26 abnormals, were selected for clinician interpretation. The kappa across cardiology specialists was "substantial" and "moderate" across primary care (0.69 vs 0.52, respectively, P < 0.001). Sensitivity and specificity to detect abnormal patterns were similar between cardiology and primary care groups (sensitivity 93.3% vs 81.3%, respectively, P = 0.31; specificity 88.8% vs 89.8%, respectively, P = 0.91).
  
  
  CONCLUSIONS
  Clinician ECG interpretation according to the ESC interpretation criteria appears to demonstrate limited reliability and validity. Before widespread adoption of ECG for PPE of U.S. athletes, further research of training focused on improved reliability and validity of clinician ECG interpretation is warranted.
authors: Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
authors: Charles
authors: C
authors: Magee
authors: Joshua
authors: J
authors: Kazman
authors: Mark
authors: M
authors: Haigney
authors: Ralph
authors: R
authors: Oriscello
authors: Kent J
authors: KJ
authors: DeZee
authors: Patricia
authors: P
authors: Deuster
authors: Patrick
authors: P
authors: Depenbrock
authors: Francis G
authors: FG
authors: O'Connor
mesh_terms: D056352:Athletes; D002983:Clinical Competence; D004562:Electrocardiography / Q000592:standards*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008403:Mass Screening; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: ECG screening; athlete ECG; preparticipation screening