Clearing Kids for Sports Participation Sparks
THURSDAY, Sept. 9 (HealthDay News) -- Most teenagers think
they're invincible, and that goes double for talented teenage
athletes. They're young, immortal, at the top of their game, the
envy of their friends.
So when news hits that an apparently healthy, high school or
college athlete has dropped dead in the midst of playing his or her
favorite sport, millions of parents get understandably anxious.
The uppermost question becomes: Should my child be screened
before participating in sports? What tests are needed? And how can
we be sure that he or she is truly healthy enough to compete?
Everyone agrees that a medical checkup before participating in
sports is crucial. But the agreement seems to stop there. At the
core of the conflict over further testing is how extensively young
athletes' hearts should be tested before they're cleared for
"I think everyone should have a doctor who evaluates them, and the doctor should know the child is going to be participating in athletics," said Dr. Paul Thompson, the director of preventive cardiology at Hartford Hospital in Connecticut, who helped write a joint position statement in 2007 from the American College of Sports Medicine and the American Heart Association.
That statement recommends cardiovascular screening for high
school and college athletes before they start participating in
athletics and at two- to four-year intervals. The screening should
include a family history, a personal history and an exam "focused
on detecting conditions associated with exercise-related events,"
according to the groups' recommendation.
But, there's more: "The AHA does not recommend routine,
additional noninvasive testing such as a routine EKG
[electrocardiogram, which assesses the heart's electrical
The American Academy of Pediatrics seems to agree. "Every
athlete should have a thorough history [taken] from the athlete as
well as the athlete's family," explained Dr. Reginald Washington, a
pediatric cardiologist and chief medical officer at Rocky Mountain
Hospital for Children in Denver and past chairman of the academy's
committee on sports medicine and fitness.
The doctor should ask about any chest pain and dizziness, and
whether the athlete has ever passed out or experienced a racing or
unusual heartbeat, Washington said. The physician should also ask
if the athlete's parents have had early heart disease, before age
55 for a man and 65 for a woman. And the physical exam, he said,
should be thorough and include listening to the heart, taking blood
pressure and feeling the pulse.
"If all of that is normal and the family history is normal, no further tests need to be done," said Washington, echoing the academy's stand.
But others disagree strongly, calling for universal and
extensive testing of all young athletes to avert future
Heart experts from Johns Hopkins Medicine in Baltimore contend
that both an EKG and an echocardiogram -- which is an ultrasound
that measures heart size, pumping function and checks for faulty
heart valves -- are crucial to detect early signs of heart defects
in young athletes because neither test alone will catch all
In testing 134 high school athletes competing in the Maryland
state track and field championships in 2008, for instance, no
life-threatening heart defects were found but blood pressure
abnormalities that required further testing and monitoring were
detected in 36 athletes, some by EKG and some by echocardiogram,
the Hopkins doctors reported at an American Heart Association
session in late 2009.
Testing in 2009, according to a Hopkins report, found a serious
heart valve disease in one track-and-field athlete and another with
an undiagnosed heart condition that could require a transplant in
the future. Neither athlete had reported any symptoms.
"If you are going to screen, it has to be comprehensive," Dr. Theodore Abraham, an associate professor at Hopkins' School of Medicine and its Heart and Vascular Institute, said in a prepared statement.
Other studies have found pros and cons to extra screening.
For instance, Harvard researchers who looked at 510 college
athletes found that screening with a history and physical exam
alone has an overall sensitivity of 45.5 percent, meaning it would
find existing problems in about 45 of every 100 athletes screened.
But adding an EKG to the screening boosted it to more than 90
However, the EKGs were also linked with a false-positive rate --
suggesting a problem when none existed -- of nearly 17 percent,
according to their report, published March 2 in the
Annals of Internal Medicine.
A separate study in that issue, on the cost-effectiveness of
such screenings, reported that adding EKGs to screenings of young
athletes saves two years of life per every 1,000 athletes, at a
per-athlete cost of $89.
Screening policies differ from region to region across the
country. In Houston, for instance, athletic trainers at 10 high
schools are using laptop systems to give young athletes EKGs, and a
doctor in the city has launched a program to provide heart
screening to all sixth-graders, eventually hoping to screen all
sixth-graders in Texas.
But there are downsides to such universal screening, others
"About 10 percent of kids who get EKGs are thought to have something the matter with them by the EKG," Thompson, the Connecticut doctor, said. "That drives additional testing, and nearly all don't have anything wrong."
The problem, he said, is not just wasted health-care dollars but
the anxiety caused by additional testing, for athletes and their
Thompson said he is not oblivious to parental worry or to the
sad reality that some athletes die unexpectedly each year.
"Every single one of these deaths is an incredible tragedy," he said, adding that he will do extra testing if parents are very worried. "But when people have looked at this, the death rate in the U.S. is about one in every 250,000 athletes. There is not really conclusive research to show [extensive testing] saves lives."
Also, in mass screenings -- where kids line up and are screened
quickly -- accuracy may suffer, said Washington, the Denver
pediatric cardiologist. "A good, thorough ultrasound should take a
half-hour," he said. "If you line up all the kids [at a school or
on a team] to have a portable ultrasound, you will miss some of
these subtle abnormalities."
But Sharon Bates, a parent who founded the Anthony Bates
Foundation after her athlete son, Anthony, died unexpectedly in
2000 and was found to have had an enlarged heart, disagrees with
the arguments against mass screenings.
Even if a problem picked up is minor, she said, you have a right
to know, and it needs to be addressed.
Bates's son had passed the typical pre-athletic physical with
flying colors, she said, yet he still had a major cardiac
Her Phoenix-based foundation promotes universal screenings for
all youth, not just athletes, she said.
As Abraham said, "What is the price for a single life?"
The Nemours Foundation has information for kids on
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