Selective use of the electrocardiogram in pediatric preparticipation athletic examinations among pediatric primary care providers

Objectives 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 ECG s 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. Conclusion 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.