By Amy Norton
NEW YORK (Reuters Health) Mar 12 - Routine electrocardiography in children could detect some cases of potentially fatal heart problems, but with many false-positives along the way, a new meta-analysis study suggests.
Children and teenagers are at very low risk of potentially fatal heart disorders. But whenever a young person dies suddenly of cardiac arrest, it's a shock -- and often widely publicized, especially deaths among young athletes.
"There's been this debate about whether ECG screening would be practical and effective in preventing these tragic deaths," said Dr. Laurel Leslie of Tufts Medical Center in Boston, the senior researcher on the new study.
Some countries, including Italy and Israel, already have mandatory EKG screening for young athletes. The U.S. is not one of them
There have also been questions about whether EKG screening could be a good idea in kids being prescribed stimulants for attention-deficit hyperactivity disorder -- though that is not currently recommended.
One of the prime arguments against such screening is that heart disorders that are detectable by EKG are so rare in kids that the risk of false-positives outweighs the potential benefits.
For the new study, published March 5th in Pediatrics, Dr. Leslie and her colleagues analyzed the potential effectiveness of routinely screening symptom-free kids for three heart disorders: hypertrophic cardiomyopathy, long QT syndrome and Wolff-Parkinson-White syndrome.
The three conditions, while rare, are the most common EKG-detectable causes of sudden cardiac death in kids, said Dr. Angie Mae Rodday of Tufts, who also worked on the study.
Using data from 30 studies on the heart conditions, the researchers found that EKG screening would have a very low risk of false negatives. But it would carry a high risk of false positives. Even under the best scenario the researchers considered, 59% of kids with a positive EKG screen would, in fact, not have any of the three heart conditions.
"That's related to the fact that these are rare disorders," Dr. Rodday said.
Based on the studies the researchers reviewed, the three heart conditions together occur at a rate of 188 cases for every 100,000 kids.
Sudden death from heart problems is rarer still. In the U.S., estimates range from less than one to about six such deaths for every 100,000 children and teens.
This study is just one step in considering whether routine EKG screening is worthwhile, Dr. Rodday said.
There's also logistics -- like who would do all of that screening? Some pediatricians have EKG devices in their offices. "But some of these disorders are pretty hard to interpret," Dr. Leslie noted.
That means it may take a pediatric cardiologist to interpret the results. And there are only about 1,500 pediatric cardiologists nationwide.
And then there's cost, Dr. Leslie said. "People point out that EKGs are inexpensive," she said, noting that the actual test runs about $10 to $25. But that's a lot when multiplied by millions of kids, and there's also the cost of interpreting those tests -- and then any follow-up that may be needed
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