Tuesday, July 10, 2007

Whither the routine electrocardiogram?

Electrocardiograms were once performed on virtually all adult hospital admissions. Although that changed in the era of cost containment there may be legitimate indications for screening electrocardiography. This company promotes screening for kids and young adults. Kevin recently linked to this skeptical piece concerning the practice. Indeed, given the rarity with which a cardiac channelopathy would be detected and appropriately acted on in a healthy population one has to wonder about cost effectiveness.

On the other hand how good is the stethoscope (or, more to the point, the thing between the ear pieces) in those assembly line style athletic pre-participation school physicals? To address that concern, investigators have looked at not only EKGs but also routine limited echocardiography as part of pre-participation screening (Clin J. Sports Med.). By doing echos at $7.34 a whack (no doubt utilizing volunteers and loaner equipment) they were able to detect a sufficient number of abnormalities to conclude it was useful. More importantly they demonstrated very poor performance of physical examination. (By the way, here’s a nice review of the topic from Clinics in Sports Medicine and here’s the AHA 2007 update).

There is some evidence that silent electrocardiographic abnormalities are quite common in older folk and that such abnormalities portend mortality and functional decline. A more liberal strategy for admission electrocardiograms may be warranted in adult hospital admissions.

Update from Kevin here.

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