Comments on: Should children be screened with an EKG prior to starting stimulants for ADHD? http://www.kevinmd.com/blog/2009/04/should-children-be-screened-with-ekg.html Tue, 14 Feb 2012 22:28:00 +0000 hourly 1 By: momwithastethoscopehttp://www.kevinmd.com/blog/2009/04/should-children-be-screened-with-ekg.html#comment-90800 momwithastethoscope Fri, 10 Apr 2009 17:36:00 +0000 http://clients.emmense.com/kevinmd/2009/04/should-children-be-screened-with-an-ekg-prior-to-starting-stimulants-for-adhd.html#comment-90800 Agree with your EKG skepticism. Is it more cost effective to screen our ADD patients in the same manner as an athlete who presents for a sports physical? A family questionaire that asks about sudden death in < 50 year old family members and symtoms such as shortnes of breath, vital signs including blood pressure & perfusion of all 4 extremities, weight, body habitus, fitness level, cardiac auscultation, and regular reevaluation are easily done in primary care offices. The differential of sudden death in children and adolescents is one most pediatricians can recite readily - tracking these causes still remain elusive (& dynamic). My point is that one EKG may identify a W-P-W, but some of these cardiac causes are acquired over time - repeated testing (yearly? biannually?) is not cost effective. Regular follow-ups for children on stimulant medications makes more sense. Agree with your EKG skepticism. Is it more cost effective to screen our ADD patients in the same manner as an athlete who presents for a sports physical? A family questionaire that asks about sudden death in < 50 year old family members and symtoms such as shortnes of breath, vital signs including blood pressure & perfusion of all 4 extremities, weight, body habitus, fitness level, cardiac auscultation, and regular reevaluation are easily done in primary care offices. The differential of sudden death in children and adolescents is one most pediatricians can recite readily – tracking these causes still remain elusive (& dynamic). My point is that one EKG may identify a W-P-W, but some of these cardiac causes are acquired over time – repeated testing (yearly? biannually?) is not cost effective. Regular follow-ups for children on stimulant medications makes more sense.

]]> By: Frank Drackmanhttp://www.kevinmd.com/blog/2009/04/should-children-be-screened-with-ekg.html#comment-90799 Frank Drackman Fri, 10 Apr 2009 16:23:00 +0000 http://clients.emmense.com/kevinmd/2009/04/should-children-be-screened-with-an-ekg-prior-to-starting-stimulants-for-adhd.html#comment-90799 1 Word: IHSS...bad enough by itself, but add potent stimulants and sprinkle some strenuous athletic activity on top, and can you say "Len Bias"??... You can have all the EMB you want, and you'll be writing a check for $42,000 only with 2 or 3 more zeros... 1 Word: IHSS…bad enough by itself, but add potent stimulants and sprinkle some strenuous athletic activity on top, and can you say “Len Bias”??… You can have all the EMB you want, and you’ll be writing a check for $42,000 only with 2 or 3 more zeros…

]]> By: Nestor L. Lopez-Duran PhDhttp://www.kevinmd.com/blog/2009/04/should-children-be-screened-with-ekg.html#comment-90796 Nestor L. Lopez-Duran PhD Fri, 10 Apr 2009 10:45:00 +0000 http://clients.emmense.com/kevinmd/2009/04/should-children-be-screened-with-an-ekg-prior-to-starting-stimulants-for-adhd.html#comment-90796 Hi, I'm not sure I follow the logic. They argue that screening is not cost-effective because it would cost $43,000 to find a single case with congenital heart disease or potentially life-threatening arrhythmia. But, assuming that the decision is made purely on financial terms, the cost should not be presented in isolation. Instead, it is only relevant when compared to how much it will cost to miss that child with potentially life-threatening conditions. <br/><br/>Any thoughts? Hi, I’m not sure I follow the logic. They argue that screening is not cost-effective because it would cost $43,000 to find a single case with congenital heart disease or potentially life-threatening arrhythmia. But, assuming that the decision is made purely on financial terms, the cost should not be presented in isolation. Instead, it is only relevant when compared to how much it will cost to miss that child with potentially life-threatening conditions.

Any thoughts?

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