There has been debate whether high school students participating in organized sports should be screened for cardiac conditions before they participate in sports. Those who favor screening advocate use of an electrocardiography (ECG) while others recommend only a thorough history and physical examination. The Clinical Decisions series presented a case of whether to initiate screening in high school athletes and a panel of physician experts presented their views. Readers were allowed to join the debate by voting and posting comments on NEJM.org. The case was also presented by the same four physicians at the American Heart Association (AHA) in November 2013. Online polls received 1,266 votes from 86 countries. 18% opposed cardiac screening, 24% favored screening with history and physical examination only and 58% favored screening with ECG, history and physical examination. U.S. voters preferred screening with only a history and physical exam. Many of the comments pointed to the lack of evidence that screening prevents death, the unfavorable cost-benefit of screening, who would be paid to read and interpret millions of ECGs, as well as what recommendations should be given to children with abnormal ECG readings. Europe is recommending ECG screening for all young athletes while currently the AHA and American Academy of Family Physicians recommend screening with only a history and physical examination. What are your thoughts regarding whether screening for cardiac conditions should be expanded to include ECG along with a history and physical examination?

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