G20(P) Cardiac screening in children planned for stimulant medications: is it necessary?. (25th October 2020) - Banerjee, S
Abstract : Introduction: ADHD (Attention Deficit Hyperactivity Disorder) affects 5–8% of children and adolescents. Stimulant medications have been proven to be an effective management strategy in many of these children. Children being considered for commencement of these stimulants are sometimes referred for cardiac screening to predict and prevent sudden death. NICE (National Institute of Clinical Excellence) has a set of criteria when cardiac screening is advised prior to commencement of treatment. However there is not much scientific data to suggest an increased risk in these children with use of stimulant medications. Aim: To look at the appropriateness of referral, investigations and outcomes of children referred to the PEC (Paediatrician with cardiac expertise) clinic for cardiac screening prior to commencement of ADHD medications. Methods: Retrospective analysis of referrals and consultation outcomes from Jan 2018 to Jan 2019. Results: 17 cases were referred by the community paediatricians to the PEC clinic. Of these 17 cases, 16 were boys and 1 was a girl. The age range was between 7–15 years with the average age being 11 years. 6 of the 17 cases were inappropriate and were not complying to NICE criteria, with the main reason being second degree relative having history of sudden deaths or pacemaker. The rest of the 11 cases were appropriate with the reasons being note of murmur, chest pains, palpitations & history of sudden death in 1st degree relative. All 17 patients had ECGs (Electrocardiogram) and echocardiography which were all reported as normal. 5 patients also had ambulatory ECG monitoring which were also normal. All 17 patients were discharged from the clinic with no cardiac contraindications found for start of stimulant medications. Discussion: Our study found that many of these referrals are inappropriate. Cardiac screening tests were normal in all patients. Many of these patients waited between 3 to 6 months to be screened in these clinics. The conclusion from this study is that delaying ADHD medications in these children is not warranted as there is substantial evidence regarding the safety and efficacy of these medications.