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Inter-Rater Reliability and Downstream Financial Implications of Electrocardiography Screening in Young Athletes.

Dhutia, H; Malhotra, A; Yeo, TJ; Ster, IC; Gabus, V; Steriotis, A; Dores, H; Mellor, G; García-Corrales, C; Ensam, B; et al. Dhutia, H; Malhotra, A; Yeo, TJ; Ster, IC; Gabus, V; Steriotis, A; Dores, H; Mellor, G; García-Corrales, C; Ensam, B; Jayalapan, V; Ezzat, VA; Finocchiaro, G; Gati, S; Papadakis, M; Tome-Esteban, M; Sharma, S (2017) Inter-Rater Reliability and Downstream Financial Implications of Electrocardiography Screening in Young Athletes. Circ Cardiovasc Qual Outcomes, 10 (8). ISSN 1941-7705 https://doi.org/10.1161/CIRCOUTCOMES.116.003306
SGUL Authors: Papadakis, Michael Sharma, Sanjay Chis Ster, Delizia Irina

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Abstract

BACKGROUND: Preparticipation screening for cardiovascular disease in young athletes with electrocardiography is endorsed by the European Society of Cardiology and several major sporting organizations. One of the concerns of the ECG as a screening test in young athletes relates to the potential for variation in interpretation. We investigated the degree of variation in ECG interpretation in athletes and its financial impact among cardiologists of differing experience. METHODS AND RESULTS: Eight cardiologists (4 with experience in screening athletes) each reported 400 ECGs of consecutively screened young athletes according to the 2010 European Society of Cardiology recommendations, Seattle criteria, and refined criteria. Cohen κ coefficient was used to calculate interobserver reliability. Cardiologists proposed secondary investigations after ECG interpretation, the costs of which were based on the UK National Health Service tariffs. Inexperienced cardiologists were more likely to classify an ECG as abnormal compared with experienced cardiologists (odds ratio, 1.44; 95% confidence interval, 1.03-2.02). Modification of ECG interpretation criteria improved interobserver reliability for categorizing an ECG as abnormal from poor (2010 European Society of Cardiology recommendations; κ=0.15) to moderate (refined criteria; κ=0.41) among inexperienced cardiologists; however, interobserver reliability was moderate for all 3 criteria among experienced cardiologists (κ=0.40-0.53). Inexperienced cardiologists were more likely to refer athletes for further evaluation compared with experienced cardiologists (odds ratio, 4.74; 95% confidence interval, 3.50-6.43) with poorer interobserver reliability (κ=0.22 versus κ=0.47). Interobserver reliability for secondary investigations after ECG interpretation ranged from poor to fair among inexperienced cardiologists (κ=0.15-0.30) and fair to moderate among experienced cardiologists (κ=0.21-0.46). The cost of cardiovascular evaluation per athlete was $175 (95% confidence interval, $142-$228) and $101 (95% confidence interval, $83-$131) for inexperienced and experienced cardiologists, respectively. CONCLUSIONS: Interpretation of the ECG in athletes and the resultant cascade of investigations are highly physician dependent even in experienced hands with important downstream financial implications, emphasizing the need for formal training and standardized diagnostic pathways.

Item Type: Article
Additional Information: This is a non-final version of an article published in final form in Dhutia, H; Malhotra, A; Yeo, TJ; Ster, IC; Gabus, V; Steriotis, A; Dores, H; Mellor, G; García-Corrales, C; Ensam, B; et al. (2017) Inter-Rater Reliability and Downstream Financial Implications of Electrocardiography Screening in Young Athletes. Circ Cardiovasc Qual Outcomes, 10 (8).
Keywords: athletes, cardiologists, death, sudden, cardiac, heart disease, sports, athletes, cardiologists, death, sudden, cardiac, heart disease, sports, athletes, cardiologists, death, sudden, cardiac, heart disease, sports, Cardiovascular System & Hematology, 1102 Cardiovascular Medicine And Haematology, 1117 Public Health And Health Services
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Cardiac (INCCCA)
Journal or Publication Title: Circ Cardiovasc Qual Outcomes
Article Number: e003306
ISSN: 1941-7705
Language: eng
Dates:
DateEvent
August 2017Published
14 August 2017Published Online
27 June 2017Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
UNSPECIFIEDCardiac Risk in the YoungUNSPECIFIED
PubMed ID: 28808091
Web of Science ID: WOS:000408110700004
Go to PubMed abstract
URI: http://sgultest.da.ulcc.ac.uk/id/eprint/109115
Publisher's version: https://doi.org/10.1161/CIRCOUTCOMES.116.003306

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