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

Abstract

BACKGROUND

Sudden cardiac death in adolescent athletes, although rare, carries substantial public health impact. Screening methods remain debated internationally. Cost effectiveness, diagnostic yield and logistical ability remain as points of contention.

AIM

To evaluate the diagnostic yield, accuracy, and cost-effectiveness of electrocardiogram (ECG)-based screening programs for adolescent athletes. The secondary aim is to discuss ethical and psychological issues that may arise from universal screening methods.

METHODS

A systematic review of literature from 1998-2025 was conducted, assessing ECG-inclusive screening, transthoracic echocardiography follow-up, and comparative international models. An additional segment was created to analyze more qualitative aspects of the screening method including psychological concerns, and physician comfortability.

RESULTS

ECG screening demonstrated superior sensitivity compared to history and physical exam alone. International programs varied in diagnostic yield, false-positive rates, and feasibility. A majority of physicians support ECG screening for athletes if proper training and financial feasibility were possible.

CONCLUSION

ECG-inclusive screening improves detection of high-risk cardiac conditions but requires careful consideration of cost, resource availability, and implementation strategies. A targeted approach to specific high-risk populations would benefit most from targeted screening and may serve as a pilot framework for future universal screening.

Keywords: Sudden cardiac death; Electrocardiogram; Pre-participation screening; Transthoracic echocardiography; Hypertrophic cardiomyopathy; Arrhythmogenic right ventricular cardiomyopathy; Cost-effectiveness analysis

Core Tip: This review evaluates the role of electrocardiogram screening in preventing sudden cardiac death among adolescent athletes, emphasizing diagnostic accuracy, cost-effectiveness, and international policy differences. By comparing American and European screening models, we highlight the balance between sensitivity, feasibility, and resource utilization. Advances such as standardized electrocardiogram interpretation criteria and artificial intelligence-assisted analysis may improve detection accuracy while reducing false positives and financial burden. These insights underscore the potential for evidence-based, equitable, and efficient cardiovascular screening strategies in young athletes.