So why isn't your son or daughter's doctor recommending it? Though your fear of such an event occurring is understandable, digging a bit into the data behind the decision not to do extensive screening may help shed some light on the decision.
Rationale for Screening Guidelines
The question of screening young athletes turns out not to be that simple. Several factors make rigorous screening difficult, expensive, and perhaps risky.First, there are several heart diseases that can increase the risk of sudden death in young people, and each of them have different criteria and require different testing procedures for making the diagnosis.
Then there is the fact that a huge number of young people would have to be screened. It is estimated that between 4 and 5 million young people participate in organized sports each year in the United States alone, but only a tiny fraction of them have underlying cardiac disease that increases their risk.
Any time screening is done for a disease with a very low prevalence, there will be many more false-positive test results (the test suggests the disease may be present when it is not) than true-positive results. Because of this, more tests will end up being conducted to get to the bottom of the suspected problem (although, in most cases, there isn't one). This can sometimes include invasive testing, such as heart catheterizations, that not only increases the personal risk to the individual but increases medical costs.
Because of these considerations, professional societies have tried to establish guidelines for screening young athletes that will be reasonably effective in detecting many of the more common heart conditions that increase risk, without generating a large number of tests because of false-positive results.
May these recommended screening examinations miss some young athletes with some underlying cardiac disorders? Unfortunately, yes.
What Are the Current Recommendations?
The American Heart Association (AHA) recommends that all high school and college athletes have a screening medical history and physical examination. The medical history should specifically bring to light any of the following symptoms:- chest pain or discomfort during exercise
- loss of consciousness
- shortness of breath on exertion
- a history of a heart murmur or hypertension
The AHA specifically does not recommend an ECG, echocardiography, or stress testing during routine screening. These tests are reserved for young people in whom there is a suspicion of a cardiac problem after doing the medical history and physical examination.
The Bottom Line
Sudden death in young athletes is fortunately very rare, and the relatively simple screening recommended by the AHA will catch many -- but not all -- of the young people who are at risk. So the AHA recommendations, which take a rare event and make it even rarer, make good sense.
Still, as a parent, you may not be happy skipping more definitive screening procedures. If you are particularly concerned about your child, discuss your concerns with your child's doctor. More testing, if you want it, is your right as a patient. However, it may also be your complete financial responsibility. And remember: While it may uncover problems that recommended testing does not, it also exposes your child to additional risks. Speak openly with your child's doctor so that you can get the information you need to balance the potential risks and benefits.
Sources:
Maron, BJ, Thompson, PD, Ackerman, MJ, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 2007; 115:1643.
