title: Selective use of the electrocardiogram in pediatric preparticipation athletic examinations among pediatric primary care providers.
abstract: OBJECTIVE
  Recent literature examining insurance administrative data suggests that a selective approach, with concurrent history and physical exam (H&P), for obtaining an electrocardiogram (ECG) as a part of a preparticipation examination (PPE) for pediatric athletes is commonly used in the primary care setting demonstrating a high rate of disease detection. We sought to understand practice patterns of providers with regard to usage of ECG as a part of PPE.
  
  
  METHODS
  Utilizing an online survey, we queried primary care providers regarding their practice patterns, rationale, and concerns regarding use of ECGs as a part of the PPE.
  
  
  RESULTS
  A total of 125 pediatricians completed the survey; 73.7% selectively use the ECG, 24.6% never use the ECG, and only 1.7% always obtain an ECG as part of the PPE. The most common rationale for selectively or never using the ECG is the belief that the H&P is sufficient to identify cardiac disease (70%). The most common H&P findings that lead to ECG screening include chest pain or syncope with exertion, family history of sudden cardiac death, an irregular heart rate, and a diastolic murmur. Among the diseases associated with sudden cardiac death, most pediatricians fear missing hypertrophic cardiomyopathy.
  
  
  CONCLUSIONS
  Based on a survey of primary care providers, most practitioners are utilizing a selective approach of obtaining an ECG as a part of a PPE for athletic participation, which is in agreement with the current American Heart Association guidelines. Significant practice variation continues to exist, and may represent an area for future resource optimization.
authors.affiliation: Division of Cardiology, Children's National Health System, Washington, DC, USA.|Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Clark
authors.affiliation: Division of Cardiology, Children's National Health System, Washington, DC, USA.|Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Hayman
authors.affiliation: Division of Cardiology, Children's National Health System, Washington, DC, USA.|Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.
authors.forename: Charles I
authors.initials: CI
authors.lastname: Berul
authors.affiliation: Division of Cardiology, Children's National Health System, Washington, DC, USA.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Burns
authors.affiliation: Division of Cardiology, Children's National Health System, Washington, DC, USA.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Kaltman
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000379:methods* / Q000706:statistics & numerical data; D010808:Physical Examination / Q000379:methods* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D013177:Sports; D014481:United States; D055815:Young Adult
keywords: history and physical; primary care providers; sudden cardiac death; survey