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Is it Time to Perform EKG (Electrocardiogram) Screenings on Young Athletes?

brennBy Fred H. Brennan, Jr., DO, FAOASM, FAAFP, FACSM

Sudden cardiac death in young athletes used to be considered “rare.”   When you consider all of the young athletes in the US, sudden death is not common, but it is certainly not rare. Because of this, the medical community and the community at large are desperately seeking ways to screen athletes in an attempt to stop or reduce sudden cardiac deaths. Should your athlete have a screening EKG in hopes of reducing his or her chance of having a cardiac event or death?

Currently it is recommended that athletes have a pre-participation comprehensive history and physical examination completed at the start of various school stages, for example, upon entry into junior high, high school, or college. The goal of this examination is to identify any medical conditions that could lead to serious injury or death in a young athlete. It also gives medical providers the opportunity to briefly counsel athletes about preventative health issues such as wearing seatbelts and abstaining from tobacco and drug use. The true usefulness and efficacy of this examination as a screening tool to prevent sudden death has been scrutinized. However, currently it is the best method we have, albeit not perfect.

There recently has been a significant push by some groups and individuals to offer and recommend screening EKGs of young athletes. Some groups offer free or reduced cost EKGs hoping to give parents some peace of mind, while also potentially giving that group some marketing opportunities. Although all of us who have children playing sports are looking for a screening test to help prevent cardiac events, EKG screening, especially mass screening, is not currently recommended by American Heart Association, the American College of Sports Medicine, the American College of Cardiology, or any other major sports medicine organization. Even the National Collegiate Athletic Association (NCAA) is struggling with this topic.

And here is why EKG screening is not currently recommended at this time:

  1.  Athlete EKGs often have variable findings which can look concerning but are in fact variations of normal. If an EKG is identified as abnormal this may spark a large, expensive, stress provoking medical workup that inevitably will reveal a normal, healthy child. In the meantime the athlete is held out of practice or competition until clearance is granted.
  2. Although there is published criteria that providers can use to review EKGs (Seattle criteria) it can still be difficult to discern normal variation from “something is really wrong here.”
  3. It is not practical to screen large numbers of athletes and have a trained cardiologist or sports medicine specialist with experience in reading EKGs review them all. It is not likely to happen at any community screening venue and to leave the interpretation up to a physician who does not regularly review pediatric or other athlete’s EKGs is risking the chance of a missed or misdiagnosis.
  4. The debate presses forward as we try to find the best screening tool to help prevent sudden cardiac events in our athletes. But there is no medical evidence that concludes that EKG screening will reduce these tragic cardiac events.
  5. Automatic External Defibrillators (AEDs), hands only CPR, and early initiation of these measures have clearly shown a reduction in cardiac deaths. Keep an AED close to your athletic events and learn how to use it.

If the current recommendations change we will certainly make an update. But for now do not be tempted to get a test (EKG) done that has not been proven to be helpful in identifying at risk athletes.

American Heart Association Study: ECG Screening of Youth: Letting Evidence and Reason Prevail