Incidence of Sudden Cardiac Death in Minnesota High School Athletes 1993-2012 Screened With a Standardized Preparticipation Evaluation

Study Questions:

What is the incidence of sudden cardiac death (SCD) during practice and competition among high school athletes screened using a uniform statewide preparticipation evaluation?


Minnesota State High School League athletes were screened at entrance and every 3 years for underlying risk of SCD using a uniform statewide preparticipation evaluation. Participation records were surveyed to determine the number of unduplicated athletes for the academic years 1993-1994 through 2011-2012. Catastrophic insurance records were used to find cardiac deaths.


There were four SCDs during practice or games among 1,666,509 unduplicated athletes participating in one or more sports. All SCDs were among male athletes; sports included cross country (n = 2), basketball (n = 1), and wrestling (n = 1). Overall, the incidence of SCD in athletes screened every 3 years with history and physical during Minnesota State High School League activities was 0.24 per 100,000 athlete-years over 19 years, and 0.11 per 100,000 athlete-years over the last decade.


The incidence of SCD in athletes screened every 3 years with a standard preparticipation evaluation form during Minnesota State High School League activities was 0.24 per 100,000 athlete-years. This incidence is much lower than that observed in studies of Division 1 NCAA and Italian athletes (ages 18-25 and mean age 24 years, respectively). The authors concluded that these data do not support screening high school athletes with an electrocardiogram (ECG) to lower the risk of SCD, and that the decision to screen athletes with ECG should consider age, training intensity, and genetic predisposition.


Controversy exists as to whether high school, college, and older athletes should undergo mandatory preparticipation ECG to screen for underlying cardiac disease that could predispose to SCD. In general, a higher risk of SCD in an athlete population suggests a greater likelihood that ECG screening would be effective. Previous studies have yielded variable rates of SCD among athletes, with the highest event rates (3.6 per 100,000 athlete-years) reported from the Padua region of Italy prior to a program that instituted mandatory ECG screening. The present results suggest that, among high school athletes in the United States, a uniform preparticipation evaluation that includes history and physical examination, but not ECG, results in a very low rate of SCD, and does not support the use of mandatory ECG screening in this group.

Clinical Topics: Heart Failure and Cardiomyopathies, Sports and Exercise Cardiology

Keywords: Athletes, Risk, Minnesota, Sports, Electrocardiography, Italy, Incidence, Death, Reference Standards, Cardiomyopathies, Schools, Genetic Predisposition to Disease, Mandatory Testing, United States, Physical Examination

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