New Data Suggest ECG Screening of High School Athletes May Not Be Warranted

"We're actually keeping our athletes quite safe at the high school level, if we simply implement the policies and procedures that we already have in place in the United States," said Christine Lawless, MD, FACC.

Data from a new study  of Minnesota State High School League (MSHSL) athletes suggest that ECG screening of high school athletes to prevent sudden cardiac death is not warranted.

The study, which looked at 1,666,509 students over a 19-year span from 1993 to 2012, found only four incidents of sudden cardiac deaths (0.24 deaths/100,000 athlete-years). Of those deaths all were in males, with two in cross country, one in basketball and one in wrestling.


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According to the authors, the MSHSL's standardized sports preparticipation history and physician evaluation (PPE) form, combined with the league's emergency action plan program called "Anyone Can Save A Life," "appears to be effective in reducing the risk of [sudden cardiac death] in high school athletes." The current PPE form requires a cardiovascular history and physical exam, followed by further diagnostic testing such as an ECG only if warranted by family history or an abnormal exam.

They authors do acknowledge that previous studies of Italian athletes and NCAA college-age athletes have indicated substantially higher rates of sudden cardiac death. However, they note that the subjects in both studies were older than high school age.

Moving forward, the authors suggest that a standardized PPE form be implemented across the national before considering moving forward with mandated ECG screening in high school athletes. They also suggest looking at the role automatic external defibrillators and/or an emergency action plan can play in reducing sudden cardiac deaths. They note that based on MSHSL informal tracking of cardiac events since 2000, 8 out of 12 students with presumed cardiac events lived as a result of AED use or implementation of the emergency action plan. "The decision to screen athletes with ECG should consider age, training intensity and genetic predisposition to avoid unnecessary false positive testing and unintended consequences, they said.

Keywords: Athletes, Genetic Predisposition to Disease, Electrocardiography, Physical Examination, Death, Sudden, Cardiac, United States

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