title: Modest agreement in ECG interpretation limits the application of ECG screening in young athletes.
abstract: BACKGROUND
  Athlete ECG screening has been recommended by several international sporting bodies; however, a number of controversies remain regarding the accuracy of ECG screening. An important component that has not been assessed is the reproducibility of ECG interpretation.
  
  
  OBJECTIVE
  The purpose of this study was to assess the variability of ECG interpretation among experienced physicians when screening a large number of athletes.
  
  
  METHODS
  A sports cardiologist, a sports medicine physician, and an electrophysiologist analyzed 440 consecutive screening ECGs from asymptomatic athletes and were asked to classify the ECGs according to the 2010 European Society of Cardiology criteria as normal (or demonstrating training related ECG changes) or abnormal. When an abnormal ECG was identified, they were asked to outline what follow-up investigations they would recommend.
  
  
  RESULTS
  The reported prevalence of abnormal ECGs ranged from 13.4% to 17.5%. Agreement on which ECGs were abnormal ranged from poor (κ = 0.297) to moderate (κ = 0.543) between observers. Suggested follow-up investigations were varied, and follow-up costs ranged from an additional A$30-A$129 per screening episode. Neither of the 2 subjects (0.45%) in the cohort with significant pathology diagnosed as a result of screening were identified correctly by all 3 physicians.
  
  
  CONCLUSIONS
  Even when experienced physicians interpret athletes' ECGs according to current standards, there is significant interobserver variability that results in false-positive and false-negative results, thus reducing the effectiveness and increasing the social and economic cost of screening.
authors.affiliation: Department of Cardiology, St. Vincent's Hospital, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia. Electronic address: maria.brosnan@svhm.org.au.
authors.forename: Maria
authors.initials: M
authors.lastname: Brosnan
authors.affiliation: Department of Cardiology, St. Vincent's Hospital, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia.
authors.forename: Andre
authors.initials: A
authors.lastname: La Gerche
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Parkville, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: SportsMed ACT, Canberra, Australia.
authors.forename: Wilson
authors.initials: W
authors.lastname: Lo
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Parkville, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kalman
authors.affiliation: Department of Cardiology, St. Vincent's Hospital, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Prior
mesh_terms: D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D056352:Athletes; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D015588:Observer Variation; D015203:Reproducibility of Results; D012307:Risk Factors; D055815:Young Adult
keywords: Electrocardiography; Interpreter variability; Screening; Sudden cardiac death