Background: Sudden cardiac death (SCD) in young athletes is a devastating event that may be preventable with effective screening. Currently, there is no universally accepted method for the pre-participation screening of athletes. Current American Heart Association guidelines recommend screening with a history and physical exam (H&P) alone, while European guidelines recommend H & P as well as a 12-lead EKG. Recent studies suggest that the EKG may be a more effective screening tool. We performed a meta-analysis to compare the effectiveness of H&P to that of a physician-read EKG in detecting cardiac disease in young athletes. 

Methods: We conducted a search of MEDLINE, PubMed, and EMBASE for studies published from 2015 to 2020 on pre-participation screening for athletes between 10 and 35 years of age. Meta-analysis of log odds ratios was conducted using a random-effects model. 

Results: Nine studies were included, with a combined sample size of 28,011 athletes screened and 124 new diagnoses of cardiac disease. The odds ratio for the association of new diagnoses of cardiac disease with H&P was 3.4 (95% confidence limits: 0.88 to 13; p=0.076). For the association of new diagnoses of cardiac disease with EKG, an odds ratio of 60 (95% confidence limits: 26 to 137; p<0.001) was obtained. After removing all cardiac conditions not related to SCD, a second analysis was performed to determine the association of H&P and EKG when screening for conditions with known risk of SCD (n=102). The association of H&P with conditions associated with SCD revealed an odds ratio of 2.9 (95% confidence limits: 0.89 to 9.49, p<0.078). For the association of EKG with conditions associated with SCD, an odds ratio of 159 (95% confidence limits: 89 to 283, p<0.001) was obtained.

Conclusion: The odds of detecting cardiac disease and conditions related to SCD with EKG are much greater than the odds of detecting them with H&P when screening young athletes.