Electrocardiogram screening in adolescent athletes - evaluating clinical protocols, outcomes, and cost-effectiveness a systemic literature review

Table 1 Quantitative studies included in the final systematic review analysis (n = 14)

Ref.	Country	Population/region	Design	Screening modality	Sample size	Primary outcome	Key findings/quantitative result
Corrado et al[26], 2006	Italy	Competitive athletes, Veneto region	Prospective cohort	H&P + ECG (mandatory)	42386	SCD incidence	89% SCD reduction (3.6/100000 to 0.4/100000 person-years)
Papadakis et al[25], 2011	United Kingdom	Voluntary youth program	Prospective registry	H&P + ECG ± TTE	32561	Diagnostic yield	0.4% serious cardiac findings; 80% detected by ECG
Harmon et al[1], 2016	United States	HS and college athletes	Observational registry	H&P only	2046000	SCD incidence	1.21/100000 person-years; low sensitivity (< 20 %)
Drezner et al[24], 2013	United States	Collegiate athletes	Comparative	H&P vs ECG ± TTE	11168	Sensitivity/specificity	ECG 94%/93%; false positives < 5 % (Seattle criteria)
Leslie et al[30], 2012	United States	Modeled athlete cohort	Economic model	ECG ± TTE vs H&P		Cost-effectiveness	42000 dollars per life-year saved (ICER)
Malhotra and Sharma[5], 2018	United Kingdom	Elite adolescent athletes	Prospective 20-year follow-up	H&P + ECG	11168	Long-term SCD prevention	0.38/100000 person-years; 80% of SCD etiologies identified
Wheeler et al[11], 2010	United States	Modeled United State athletes	Economic simulation	H&P vs ECG ± ECHO		Cost per life saved	> 10 thousand dollars/life year saved (early); improved < 7 thousand dollars with newer criteria
Steinvil et al[22], 2011	Israel	National cohort	Retrospective trend	Mandatory ECG	National registry data over 12 years	SCD trend	No statistically significant SCD reduction
Baggish et al[15], 2017	United States	Collegiate athletes	Mixed observational	H&P ± ECG	510	Diagnostic yield	6 pathologies found only by ECG; cost per case approximately 11000 dollars
Moulson et al[33], 2021	Canada	Multicenter athletes	Prospective pilot	H&P + ECG	2120	Feasibility/FP rate	FP 3.2%; supports international criteria use
Petek and Baggish[23], 2020	United States	Sports-medicine clinicians	Survey-based quantitative	H&P ± ECG	125	Implementation feasibility	68% cited training barriers; 72% favored ECG inclusion
Hernelahti et al[36], 2008	Nordic	National registries	Policy analysis/quantitative comparison	H&P vs proposed ECG		Policy outcome	Cost-burden model > 150 thousand dollars/life year saved; ECG not adopted
Dhutia et al[12], 2021	United Kingdom	Health-policy review	Quantitative + ethical	H&P + ECG ± genetic		Cost/risk model	Supported selective screening in high-risk sports
Asif et al[38], 2014	United States	HS athletes ± parents	Mixed-methods (survey + rates)	H&P + ECG	410	Psychological/compliance data	92% reported reassurance post-ECG; FP 4%

HS: High school; H&P: History and physical examination; ECG: Electrocardiogram; TTE: Transthoracic echocardiogram; ECHO: Echocardiogram; SCD: Sudden cardiac death; FP: Feasibility probability; ICER: Incremental cost-effectiveness ratio.