Article

In recent years various proposals and subsequent changes have been
made to improve pre-participation screening (PPS) methods. This study examines
the Lausanne questionnaire and the old and new ESC criteria for a positive
electrocardiogram (ECG) in athletes. DESIGN: Retrospective cohort study. METHODS:
All consecutive students undergoing a PPS between January and July 2011 were
included. The screening consisted of the Lausanne questionnaire, a physical
examination, and a 12-lead ECG. RESULTS: A total of 561 students were screened. A
total of 310 students (55%) answered positively to one or more of the Lausanne
questions and 49 (9%) of these abnormalities were assessed as medically relevant.
Physical examination was abnormal in nine (1.6%) students. In total, 120 (21%)
ECGs were found positive following the old criteria. According to the new
criteria, 68 (12%) ECGs were found positive. Four (already known) congenital
cardiac disorders and four new diagnoses were found. When using the new ECG
criteria, two out of four new cardiovascular diagnoses would have been missed.
CONCLUSIONS: The use of the Lausanne questionnaire provides many irrelevant
findings causing unnecessary positive screening outcomes. With the new ESC
criteria for a positive 12-lead ECG in athletes, the number of false-positive
screenings greatly decrease: however, at the cost of an increase in the number of
false-negatives. To reach a conclusive judgment on the cost:benefit ratio of PPS,
it is necessary to have a validated discriminating questionnaire, specific
medical knowledge of PPS and clear definitions of a normal and abnormal 12-lead
ECG in athletes.
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Langue : ANGLAIS