Is your young athlete at risk for sudden cardiac death (SCD)?
According to an article from the American Heart Association, in the United States, SCD is responsible for approximately 100-150 deaths annually during sporting events. That’s an average of one athlete every 3 days experiencing a SCD on the athletic field. The American Heart Association (AHA) protocol recommends that a personal and family medical history be taken and a physical examination be performed on all competitive athletes. Many causes of SCD may not present themselves with a history and physical exam alone. Therefore, the question that arises is whether or not additional tests would be beneficial in the SCD screening process.
Several trials and studies have been conducted to answer this question. At the Heart Rhythm 2014 meeting in San Francisco, the press release, Addition of Electrocardiogram (ECG) To Pre-Participation Screening Of Young Athletes Is Most Efficient At Finding Heart Abnormalities was presented. This trial was conducted between 2010 and 2013 at U.S. high schools and looked at including a resting 12-lead ECG and, when indicated, limited echocardiogram in addition to the AHA recommendations for preparticipation screening of high school athletes. The results of this trial indicated that ECG had a significantly lower false positive rate (3.6%) when compared to history (22.3%) and physical examination (14.9%). ECG also had a better positive predictive value (8.6%) when compared to history (1.0%) and physical examination (1.0%). This trial concluded that ECG should be considered for pre-participation screening in young athletes.
Additionally, Usefulness of Echocardiography in Preparticipation Screening of Competitive Athletes, was a study conducted to evaluate the prevalence of cardiac structural changes with the use of echocardiography in pre-participation screening of competitive athletes. In this study, 7.5% of the athletes showed structural changes and cessation of athletic activity was indicated in 1.8% of the athletes studied. This study concluded that some cardiac structural changes can be missed on physical examination and ECG, but are easily found with echocardiography. This study concluded that the use of echocardiography in at least the first pre-participation screening of competitive athletes is suggested.
As the awareness of SCD becomes more widespread, the availability of multi-test screenings is also becoming more accessible. Many local screenings such as Living for Zachary in north Texas include an ECG as well as an echocardiogram in their pre-participation screening of the young competitive athlete. The current barrier that is preventing these additional modalities from being included in the standard protocol is cost. These multi-test screenings are currently not covered by insurance. However, several local screenings and hospitals are working together to help reduce this cost to help make this potentially life-saving test available to more student athletes.