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

Détails

ID Serval
serval:BIB_2C8983F4AD87
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Inter-Rater Reliability and Downstream Financial Implications of Electrocardiography Screening in Young Athletes.
Périodique
Circulation. Cardiovascular quality and outcomes
Auteur(s)
Dhutia H., Malhotra A., Yeo T.J., Ster I.C., Gabus V., Steriotis A., Dores H., Mellor G., García-Corrales C., Ensam B., Jayalapan V., Ezzat V.A., Finocchiaro G., Gati S., Papadakis M., Tome-Esteban M., Sharma S.
ISSN
1941-7705 (Electronic)
ISSN-L
1941-7713
Statut éditorial
Publié
Date de publication
08/2017
Peer-reviewed
Oui
Volume
10
Numéro
8
Pages
e003306
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
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.
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.
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.
Mots-clé
Adolescent, Adult, Age Factors, Arrhythmias, Cardiac/complications, Arrhythmias, Cardiac/diagnosis, Arrhythmias, Cardiac/economics, Arrhythmias, Cardiac/mortality, Athletes, Clinical Competence, Cost-Benefit Analysis, Death, Sudden, Cardiac/etiology, Death, Sudden, Cardiac/prevention & control, Electrocardiography/economics, Female, Health Care Costs, Humans, Logistic Models, Male, Multivariate Analysis, Observer Variation, Odds Ratio, Predictive Value of Tests, Prognosis, Reproducibility of Results, Risk Assessment, Risk Factors, Young Adult, athletes, cardiologists, death, sudden, cardiac, heart disease, sports
Pubmed
Web of science
Open Access
Oui
Création de la notice
06/09/2017 11:53
Dernière modification de la notice
20/08/2019 14:11
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