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

Table 2 Qualitative and mixed-methods studies included in final synthesis (n = 13)

Ref.	Country	Population/region	Design/approach	Focus area	Key themes/findings
Asif et al[38], 2014	United States	High-school athletes ± parents	Survey + focus groups	Psychologic impact of ECG screening	(1) False-positive ECGs did not raise anxiety; and (2) Most athletes felt safer and more confident resuming play
Dhutia et al[12], 2021	United Kingdom	Policy experts/clinicians	Narrative review + ethical analysis	Ethical proportionality of mass screening	Advocates context-specific, risk-proportionate screening and shared decision-making
Petek and Baggish[23], 2020	United States	Sports medicine physicians/ATs	Semi-structured survey	Implementation feasibility	Training deficits, variable institutional support, and limited follow-up access identified as key barriers
Hernelahti et al[36], 2008	Nordic countries	Public-health authorities	Policy comparison/qualitative	National screening policy	Nordic taskforce declined national ECG program citing cost, limited yield, and equity concerns
Baggish et al[15], 2017	United States	Collegiate athletes	Mixed-methods observational	Clinical utility + attitudes	(1) ECG added clinical reassurance; and (2) Athletes and clinicians viewed program as acceptable and feasible
Moulson et al[33], 2021	Canada	Multicenter pilot participants	Prospective + feasibility interviews	Workflow + perception	(1) Positive reception; (2) 3.2 % false positives; and (3) Supports standardized interpretation criteria
Steinvil et al[22], 2011	Israel	Policymakers/registry review	Mixed quantitative-qualitative	Policy evaluation	(1) National mandate showed no clear SCD decline; and (2) Prompted debate about cost-benefit and implementation
Harmon et al[35], 2015	United States	Collegiate sports programs	Qualitative analysis of registries	Health-system disparities	Highlighted racial/socioeconomic inequities in SCD events and screening access
Drezner et al[34], 2017	United States	Athletic trainers + team physicians	Survey study	Knowledge and training attitudes	78% desired ECG training; 64% supported integration if cardiology follow-up available
Malhotra and Sharma[5], 2018	United Kingdom	Elite adolescent athletes	Thematic follow-up interviews	Emotional impact of disqualification	(1) Temporary disqualification caused distress; and (2) Long-term acceptance after counseling is possible unforeseen expense
Sharma et al[32], 2017	International	Consensus experts/societies	Delphi consensus process	Guideline development	Produced International ECG interpretation criteria, standardized approach reducing false positives
Roberts et al[37], 2015	United States	Sports medicine professionals	Narrative review/ethical discourse	Screening philosophy	(1) Compared ECG screening with other public-health screenings (Pap, PSA); and (2) Discussed utilitarian ethics
Corrado et al[39], 1998	Italy	Young athletes/families	Retrospective interviews	Psychosocial effects of disqualification	(1) Emotional burden significant; and (2) Counseling mitigates risk of depression/suicide in disqualified youth

AT: Athletic trainer; ECG: Electrocardiogram; SCD: Sudden cardiac death; PSA: Prostate-specific antigen.