Evaluation of electrocardiogram as a biological signal for sex verification among fresh undergraduates in a Nigerian tertiary institution

Abstract

Background: Sex verification using electrocardiogram (ECG) is a new application of the biological signal. Objective: This study aimed to determine the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of an electrocardiographic score in sex verification. Methods: A total of 2442 apparently healthy fresh undergraduates who presented for health screening in a tertiary institution were recruited for the study. The technical team documented the sex of the participants and had their resting 12-lead ECG recorded according to standard protocol. Two physicians who were blinded to the participants and the recorded sex utilized Ogunlade Sex Determination Electrocardiographic Score (OSDES) to determine the sex. The validity of OSDES was estimated using sex recorded by the technical team as the standard while the accuracy of scoring system was determined using receiver operating characteristic curve. Results: The mean (± standard deviation) of age of the participants was 20.71 ± 3.62 years. Among the male population, true positives (TPs), false positives (FPs), false negatives (FNs), and true negatives (TN) were 1131, 49, 90, and 1172, respectively. Among the females TP, FP, FN, and TN were 1172, 90, 49, and 1131, respectively. Among males, the sensitivity, specificity, PPV, and NPV were 92.63% (95% confidence interval [CI]: 91.02-94.03%), 95.99% (95% CI: 94.73-97.02%), 95.85% (95% CI: 94.55-96.91%), and 92.87% (CI: 91.31-94.23%) respectively while among the females, the sensitivity, specificity, PPV, and NPV were 95.99% (95% CI: 94.73-97.02%), 92.63% (95% CI: 91.02-94.03%), 92.87% (95% CI: 91.31-94.23%), and 95.85% (95% CI: 91.02-94.03%) respectively. The area under curve was 0.943. Conclusion: This study concluded that ECG has a reasonable level of sensitivity and specificity with excellent accuracy in verification of sex among fresh Nigerian undergraduates.