title: Usefulness of combined history, physical examination, electrocardiogram, and limited echocardiogram in screening adolescent athletes for risk for sudden cardiac death.
abstract: Sudden cardiac death in the young (SCDY) is the leading cause of death in young athletes during sport. Screening young athletes for high-risk cardiac defects is controversial. The purpose of this study was to assess the utility and feasibility of a comprehensive cardiac screening protocol in an adolescent population. Adolescent athletes were recruited from local schools and/or sports teams. Each subject underwent a history and/or physical examination, an electrocardiography (ECG), and a limited echocardiography (ECHO). The primary outcome measure was identification of cardiac abnormalities associated with an elevated risk for sudden death. We secondarily identified cardiac abnormalities not typically associated with a short-term risk of sudden death. A total of 659 adolescent athletes were evaluated; 64% men. Five subjects had cardiac findings associated with an elevated risk for sudden death: prolonged QTc >500 ms (n = 2) and type I Brugada pattern (n = 1), identified with ECG; dilated cardiomyopathy (n = 1) and significant aortic root dilation; and z-score = +5.5 (n = 1). History and physical examination alone identified 76 (11.5%) subjects with any cardiac findings. ECG identified 76 (11.5%) subjects in which a follow-up ECHO or cardiology visit was recommended. Left ventricular mass was normal by ECHO in all but 1 patient with LVH on ECG. ECHO identified 34 (5.1%) subjects in whom a follow-up ECHO or cardiology visit was recommended. In conclusion, physical examination alone was ineffective in identification of subjects at elevated risk for SCDY. Screening ECHO identified patients with underlying cardiac disease not associated with immediate risk for SCDY. Cost of comprehensive cardiac screening is high.
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: jeffrey.anderson@cchmc.org.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Anderson
authors.affiliation: University of Mississippi Medical Center, Jackson, Mississippi.
authors.forename: Michelle
authors.initials: M
authors.lastname: Grenier
authors.affiliation: Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Edwards
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Nicolas L
authors.initials: NL
authors.lastname: Madsen
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Czosek
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: David S
authors.initials: DS
authors.lastname: Spar
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Allison
authors.initials: A
authors.lastname: Barnes
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Jesse
authors.initials: J
authors.lastname: Pratt
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Eileen
authors.initials: E
authors.lastname: King
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Knilans
mesh_terms: D000293:Adolescent; D001018:Aortic Diseases / Q000150:complications / Q000175:diagnosis*; D056352:Athletes; D053840:Brugada Syndrome / Q000150:complications / Q000175:diagnosis*; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000175:diagnosis*; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D004108:Dilatation, Pathologic; D004452:Echocardiography / Q000191:economics / Q000379:methods*; D004562:Electrocardiography / Q000191:economics / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000175:diagnosis*; D008133:Long QT Syndrome / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods; D008487:Medical History Taking / Q000379:methods*; D010808:Physical Examination / Q000379:methods*; D011446:Prospective Studies; D018570:Risk Assessment