Electrocardiography-inclusive screening strategies for detection of cardiovascular abnormalities in high school athletes
Section snippets
Study design
This prospective study evaluated the prevalence of cardiac conditions in athletes at two large PPS events in June 2010 and June 2011. All athletes underwent a screening evaluation that included (1) a personal and family history with physical examination; (2) ECG; and (3) limited echo. Athletes with abnormal screening results were followed until a definitive diagnosis was made. The study was approved by the Institutional Review Board of Carolinas Healthcare System, and all participants provided
Demographics
A total of 2017 high school athletes (71% male) seeking medical clearance for competitive sports were screened. The ethnicity of the athletes was added to the registration form in 2011, so demographic data are available only for that year. The athletes were 34% Caucasian, 31% black/African American, 5% Hispanic, 1% Asian, and 25% other ethnicity (checked ≥2 ethnicities); 4% did not respond. The athletes represented 14 different sports.
Primary and secondary outcomes
In this cohort of 2017 screened athletes, five primary
Discussion
The American College of Cardiology states that the “ultimate objective of PPS of athletes is the detection of silent cardiovascular abnormalities that can lead to SCD.”33 Similar to previous research, this study demonstrates that history and physical examination alone has limited ability to detect potentially lethal cardiovascular abnormalities in a population of young athletes, and that the addition of ECG to PPS improves early detection of athletes with abnormalities associated with SCD.
Conclusion
Our findings suggest that an integrated PPS consisting of history, physical examination, and ECG provides improved detection of conditions associated with SCD in high school athletes. When modern interpretation standards are used, ECG has an acceptably low false-positive rate and high negative predictive value for the presence of cardiomyopathy. The use of echo has the potential to identify additional minor cardiac abnormalities, but the clinical significance requires further study. In order to
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2019, Journal of Pediatric Health CareCitation Excerpt :These can be asymptomatic and therefore go undetected during routine history and physical exams (Goldberger et al., 2014). Of all the possible causes of SCD, HCM is still the most common, resulting in over one third of deaths in young athletes, because up to 75% do not present with an audible murmur during a resting cardiac examination (Maron, Haas, Ahluwalia, Murphy, & Garberich, 2016; Price et al., 2014). Fatal cardiomyopathies, even though rare in young athletes, may be more common than previously thought (Harmon et al., 2016).