Stimulants and ECGs

The number of electrocardiograms ordered for children prescribed stimulants increased fourfold after the AHA recommendation for universal ECG screening.

In April 2008, the American Heart Association (AHA) published a scientific statement suggesting electrocardiogram (ECG) screening for all children and adolescents who are prescribed stimulant medication (JW Pediatr Adolesc Med Apr 30 2008). In August of the same year, the American Academy of Pediatrics published a policy statement indicating that history and physical examination alone are sufficient to screen for possible cardiac abnormalities and that routine use of ECG is not recommended. In a retrospective study from Texas Children's Hospital, investigators examined the effect of the AHA statement on practice by community pediatricians.

The average number of ECGs ordered for children prescribed stimulant medications increased from 6.9 per month before the AHA statement to 31.2 per month during the following year. Of the 372 referred children, 24 (6.4%) had abnormal ECGs, and 18 of these patients were referred for further evaluation. To date, no patient has received a diagnosis with definitive cardiac disease or has been restricted from taking stimulant medications based on ECG results. In a survey, 65% of responding pediatricians reported that the AHA statement did not alter their practice, and 35% said they were ordering more ECGs.

Comment

Between 1992 and 2005, 28 children of the many millions who were taking stimulants died suddenly. Of these, 12 had underlying structural cardiovascular abnormalities. Whether ECG screening would have detected any of these cases is uncertain. Clearly, the results from a single center are limited. Nevertheless, this study raises questions about the value of routine ECGs and demonstrates how a single policy statement can change practice. As we become more risk averse, I suspect that many clinicians will continue to order ECGs for children taking stimulants despite the lack of data indicating that this practice saves lives.

Reviewing Author

Howard Bauchner, MD

Disclosures

Grant / research supportHuman Resources and Services Administration; NIH; NIH-NHLBI; USDA; GlaxoSmithKline

Editorial boardsArchives of Disease in Childhood (Editor-in-Chief)

Howard Bauchner, MD

Disclosures

Grant / research supportHuman Resources and Services Administration; NIH; NIH-NHLBI; USDA; GlaxoSmithKline

Editorial boardsArchives of Disease in Childhood (Editor-in-Chief)

Citation(s):

Thomas PE et al. Impact of the American Heart Association scientific statement on screening electrocardiograms and stimulant medications. Arch Pediatr Adolesc Med 2011 Feb; 165:166.