Each year between 10–12 million kids in the U.S. participate in sports. The tragedy of a sudden death in an otherwise “presumably healthy” child causes not only sadness, but concern as to how the death might have been prevented. Doctors are often asked, “isn’t there a test or something to prevent this? “.
Depending on the studies I have read, the sudden cardiac death of a child or adolescent accounts for about 100 deaths a year in the U.S. The prevalence rate for sudden cardiac death is 1:100,000- 200,000 and is higher among males than females. Statistics show that 90% of these sudden deaths occur immediately post training or competition with football and basketball having the highest incidence.
In 2007 the American Heart Association came out with guidelines to evaluate athletes who may be at risk for sudden cardiac death. The most important screening mechanism has been found to be the “gold standard” in medicine, a thorough history and physical exam. The history that should be taken on any athlete who is being screened for sports participation should include a history of any unexplained or sudden death in a family member. Are there any family members with unexplained fainting episodes or seizures? Are there family members who had unexplained deaths (drowning or single car accidents)? Are there any family members with a known genetic disorder that predisposes to sudden cardiac death? The history should also ask about any fainting (syncope) in the athlete.
After a good history is taken (which should be updated yearly), the child/adolescent needs a complete and thorough physical exam. This exam should include blood pressure measurements, and a careful cardiac exam looking for new murmurs. Symptoms such as palpitations during exercise, visual changes, fainting while exercising or immediately after exercise, and chest pain should all warrant further evaluation. Studies show that about half of pediatric patients who succumb to sudden cardiac death had experienced a warning sign.
There are about 20 causes for SCD, with the most common causes being hypertrophic cardiomyopathy, anomalous coronary artery, and myocarditis. While some may advocate routine EKG screening and echocardiograms on athletes (this is done in Italy), many studies have been done which show that it would take the screening of 200,000 student athletes to prevent 1 death. At the same time you will certainly identify some children with clear risk factors for SCD, but for every positive finding there may be 10–20 athletes who have “borderline” or questionable findings that would require even more expensive follow up. These pediatric patients might also be told they cannot participate in sports during the evaluation time and some might be told that they cannot participate even if they were not found to have disease, but were excluded just due to liability concerns.
There does not seem to be one right answer to this issue. If your child is going to begin competitive sports make sure to see your pediatrician for a complete physical exam including a good family history. Also advocate that your school have automatic external defibrillators viable at all times and personnel that know how to use them. That's your daily dose for today. We'll chat again tomorrow.