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Diagnostic accuracy and Bayesian analysis of new international ECG recommendations in paediatric athletes.

McClean, G; Riding, NR; Pieles, G; Watt, V; Adamuz, C; Sharma, S; George, KP; Oxborough, D; Wilson, MG (2019) Diagnostic accuracy and Bayesian analysis of new international ECG recommendations in paediatric athletes. Heart, 105 (2). pp. 152-159. ISSN 1468-201X https://doi.org/10.1136/heartjnl-2018-313466
SGUL Authors: Sharma, Sanjay

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Abstract

OBJECTIVE: Historically, electrocardiographic (ECG) interpretation criteria for athletes were only applicable to adults. New international recommendations now account for athletes ≤16 years, but their clinical appropriateness is unknown. We sought to establish the diagnostic accuracy of new international ECG recommendations against the Seattle criteria and 2010 European Society of Cardiology (ESC) recommendations in paediatric athletes using receiver operator curve analysis. Clinical context was calculated using Bayesian analysis. METHODS: 876 Arab and 428 black male paediatric athletes (11-18 years) were evaluated by medical questionnaire, physical examination, ECG and echocardiographic assessment. ECGs were retrospectively analysed according to the three criteria. RESULTS: Thirteen (1.0%) athletes were diagnosed with cardiac pathology that may predispose to sudden cardiac arrest/death (SCA/D) (8 (0.9%) Arab and (5 (1.2%) black)). Diagnostic accuracy was poor (0.68, 95% CI 0.54 to 0.82) for 2010 ESC recommendations, fair (0.70, 95% CI 0.54 to 0.85) for Seattle criteria and fair (0.77, 95% CI 0.61 to 0.93) for international recommendations. False-positive rates were 41.0% for 2010 ESC recommendations, 21.8% for Seattle criteria and 6.8% for international recommendations. International recommendations provided a positive (+LR) and negative (-LR) post-test likelihood ratio of 9.0 (95% CI 5.1 to 13.1) and 0.4 (95% CI 0.2 to 0.7), respectively. CONCLUSION: In Arab and black male paediatric athletes, new international recommendations outperform both the Seattle criteria and 2010 ESC recommendations, reducing false positive rates, while yielding a 'fair' diagnostic accuracy for cardiac pathology that may predispose to SCA/D. In clinical context, the 'chance' of detecting cardiac pathology within a paediatric male athlete with a positive ECG (+LR=9.0) was 8.3%, whereas a negative ECG (-LR=0.4) was 0.4%.

Item Type: Article
Additional Information: This article has been accepted for publication in Heart, 2019 following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/heartjnl-2018-313466. © Author(s) (or their employer(s)) 2019.
Keywords: Ecg/electrocardiogram, 1102 Cardiovascular Medicine And Haematology, Cardiovascular System & Hematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Heart
ISSN: 1468-201X
Language: eng
Dates:
DateEvent
January 2019Published
18 September 2018Published Online
23 July 2018Accepted
Publisher License: Publisher's own licence
PubMed ID: 30228247
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/110529
Publisher's version: https://doi.org/10.1136/heartjnl-2018-313466

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