Prospective screening of 5,615 high school athletes for risk of sudden cardiac death

Abstract

Sudden cardiac death among high school athletes is a very infrequent though tragic occurrence. Despite widespread preparticipation screening for known causes of this event, the frequency has not changed. The ECG is an acknowledged sensitive screening tool for the common causes of sudden cardiac death in young athletes. The specificity of the ECG in this setting is believed to be relatively low in young athletes for which reason, in part, it is not used. We added an ECG to the usual preparticipation screening. An echocardiogram was performed when screening was abnormal. Outcome measures of serious or potentially serious cardiovascular abnormalities were defined by the 16th Bethesda Conference. These abnormalities either preclude sports participation or require further testing before approval for participation in sports can be considered. Over 3 yr, 5,615 male and female high school athletes were screened prospectively from 30 different high schools in northern Nevada. Outcome measures were detected in 22 athletes or one per 255. Cardiac history led to detection of outcome measures in 0 athletes, auscultation/inspection in 1/6,000 athletes, blood pressure measurement in 1/1,000 athletes, and the ECG in 1/350 athletes. Specificity was 97.8% for an abbreviated cardiac history and auscultation/inspection and 97.7% for ECG. Overall, the ECG was a much more effective screening tool than cardiac history and auscultation/inspection in detecting cardiovascular abnormalities requiring further tests before approval for participation in sports could be given. ECG and cardiovascular history/ausculation/inspection had similar specificity ECG was efficiently performed on large groups of high school athletes.

Sudden cardiac death in athletes: the Lausanne Recommendations

“…The existing protocols ail include a medical history and a physical examination, in some cases diagnostic tests, of varying content. The persan performing the screening is also variable, some places allowing non-physicians [19,68,70,72,74,76,78,79,89,90] to conduct the examination, which decreases the chances of positive findings. One wonders what the results will be when technicians, nurses, chiropractors, or athletic trainers perform the cardiovascular screening.…”

Sport and sudden death in children

“…В штате Невада (США) был проведен анализ ЭКГ у 5615 юных спор-тсменов, выявивший, что чувствительность этого ме-тода в идентификации серьезной кардиоваскулярной патологии составила 70% по сравнению с 3% при ис-пользовании только данных анамнеза и физикаль-ного осмотра [25]. Специфичность ЭКГ составила 97,4%, но только 0,4% (22 из 5615) детей были отве-дены от спортивных соревнований.…”

Pediatric Sudden Cardiac Arrest

“…50 Some US studies have suggested that ECG screening may be cost-effective on the basis of estimated cost per year of lives saved. 51,52 The 2007 AHA scientific statement/ screening guidelines 44 (coauthored by S.B. and M.J.A.)…”