title: Electrocardiogram in Preparticipation Athletic Evaluations among Insured Youths.
abstract: OBJECTIVE
  To retrospectively characterize electrocardiogram (ECG) use among preparticipation history and examinations (PPEs).
  
  
  METHODS
  Using the 2005 to 2010 MarketScan insurance database, we identified subjects aged 5-21 years with either a PPE with an ECG or a PPE alone, excluding those with known cardiac diagnoses. We described cardiology referrals and subspecialty testing within 180 days and cardiac diagnoses within 1 year of the PPE, and the costs of testing in each group.
  
  
  RESULTS
  From 2005-2009, 503 304 PPEs occurred in 419 456 subjects, of which 8621 (2%) included an ECG. ECG use increased from 12-20 per 1000 PPEs from 2005-2009. Females, lower socioeconomic status, and rural settings were associated with fewer ECGs. Thirteen percent of PPEs with ECG and 0.5% of PPEs alone led to a cardiology referral. After PPEs with ECG, cardiac disease was identified in 18% (2% sports-limiting); after PPEs alone, cardiac disease was identified in 0.5% (0.03% sports-limiting). The PPE had a sensitivity of 44% and a specificity of 98.6% of identifying cardiac disease. The total reimbursement cost of PPEs plus testing was $80 396 464 ($160 per PPE).
  
  
  CONCLUSIONS
  These real-world data demonstrate that community providers selectively use the ECG as part of the PPE with a high rate of identification of cardiac disease. Mass ECG screening would need to be more efficient at identifying disease than this selective approach.
authors.affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Electronic address: kristin.burns@nih.gov.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Burns
authors.affiliation: Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, MD.
authors.forename: William E
authors.initials: WE
authors.lastname: Encinosa
authors.affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Gail D
authors.initials: GD
authors.lastname: Pearson
authors.affiliation: National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Kaltman
mesh_terms: D000293:Adolescent; D000328:Adult; D002309:Cardiology / Q000379:methods* / Q000592:standards; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography / Q000706:statistics & numerical data*; D005189:False Positive Reactions; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008403:Mass Screening; D010808:Physical Examination; D012017:Referral and Consultation; D012189:Retrospective Studies; D012424:Rural Population; D012680:Sensitivity and Specificity; D012923:Social Class; D013177:Sports; D013334:Students; D014481:United States; D055815:Young Adult