title: Usefulness and cost effectiveness of cardiovascular screening of young adolescents.
abstract: OBJECTIVE
  This study was conducted to assess the usefulness of a screening system for cardiovascular disease in Kagoshima, Japan, and to compare its cost-effectiveness with that of a similar system reported in the United States.
  
  
  BACKGROUND
  Preparticipation screening of young athletes has been implemented in many countries to prevent sudden death, but sudden death in young nonathletes remains a problem. In Japan, both athletes and nonathletes have been screened for the presence or absence of cardiovascular diseases for more than 20 yr.
  
  
  METHODS
  From 1989 to 1997, all seventh graders in schools in Kagoshima, Japan, were screened for cardiovascular disease using a questionnaire and electrocardiogram before physical examination. They were screened again in the same way 3 yr later. One subject newly diagnosed with cardiovascular disease and recommended to limit athletic participation was defined as "high-risk." Situations leading to cases of sudden death were verified with a report from the school in question.
  
  
  RESULTS
  Of the initial study population, 99% participated in the program every year. A total of 37,807 subjects, including nine high-risk subjects, were evaluated consecutively for 6 yr. Of these nine subjects, six, including three patients with hypertrophic cardiomyopathy, were nonathletes. Three sudden deaths occurred during the study period; one student was from the high-risk group. The cost of this screening system was lower than that reported in the United States.
  
  
  CONCLUSIONS
  Population-based screening for heart disease in this age range is limited by various factors. To analyze the mechanisms of sudden death in adolescents, we, therefore, are in need of a nationwide registry that includes autopsies for all deadly events.
authors.affiliation: National Hospital Organization Kyusyu Cardiovascular Center, Shiroyamacho, Kagoshima City, Kagoshima, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Masao
authors.initials: M
authors.lastname: Yoshinaga
authors.forename: Ryuichiro
authors.initials: R
authors.lastname: Anan
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Nomura
authors.forename: Shozo
authors.initials: S
authors.lastname: Oku
authors.forename: Seiji
authors.initials: S
authors.lastname: Nishi
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kawano
authors.forename: Chuwa
authors.initials: C
authors.lastname: Tei
authors.forename: Katsura
authors.initials: K
authors.lastname: Arima
mesh_terms: D000293:Adolescent; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D002648:Child; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D004562:Electrocardiography / Q000191:economics*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D010808:Physical Examination / Q000191:economics*; D011795:Surveys and Questionnaires / Q000191:economics*