Best practices for ECG screening in children

•There are no data to support the efficacy of the current preparticipation screening in children, which is aimed at middle and high school athletes and includes only a history and physical exam.•Addition of the ECG has been shown to be more effective in identifying conditions associated with sudden cardiac death than the history and physical examination alone.•It has been shown by several screening models to be feasible to include an ECG in the preparticipation screening or general cardiovascular screening of children.•It is logical that using the best method to identify those at risk would be a current best practice.•Best practice models are presented and discussed.

Screening for conditions associated with sudden cardiac arrest in the United States (US) is aimed at high school athletes in most states and utilizes a preparticipation history and physical form that is not standardized across the US. In Italy, data have shown that their incidence of sudden cardiac arrest has decreased significantly after implementation of an electrocardiographic-based screening program including history and physical exam. The American Heart Association recommendations do not include an electrocardiogram. A recent AHA statement has suggested that those screening athletes should consider all children of similar ages in the selected venue, but still should not include an electrocardiogram. A number of models of screening are presented along with a best practice recommendation for further evaluation and study.