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Can a New Screening Protocol Help Prevent Sudden Death in Athletes?

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Each year in the United States, nearly a dozen young competitive athletes die unexpectedly while participating in a sporting event. By screening athletes for dangerous health issues prior to participating in these activities, many of these deaths can be prevented.

The current screening program is limited, consisting of an American Heart Association 16 point history and physical examination. There is controversy whether additional testing such as electrocardiography will improve disease detection. Additional testing has proven to be overly sensitive, leading to unnecessary referrals to cardiologists, delays in sports participation and unnecessary costs. There is ongoing debate regarding the specific components of screening that should be incorporated.

Gianmichel Corrado, MD, sports medicine physician at Boston Children’s Hospital and head team physician for Northeastern University, brought the idea of researching this topic to Frederick Basilico, MD, chair of department of medicine and chief of cardiology at NEBH. Together* they conducted a study to find out if a new screening protocol (ESCAPE: Early Screening for Cardiovascular Abnormalities With Preparticipation Focused Echocardiography) would improve false-positive rates, reduce referrals, and broaden the spectrum of disease that can be captured through preparticipation screening of athletes.

The Study

The study was conducted with sixty-five male collegiate athletes, ages 18 to 25. To begin, each athlete was screened with a history and physical examination, an electrocardiography (ECG), and focused echocardiography performed by a noncardiologist sports medicine physician. Focused physician-operated echocardiography was performed to assess for hypertrophic cardiomyopathy and aortic root dilatation. Athletes screening positive were referred to a cardiologist for further testing.

Results

  • Most of the 59 athletes did not screen positive by any screening modality.
  • Three athletes screened positive on ECG but had normal focused echocardiographic findings.
  • Three athletes screened positive by history and physical examination but had normal ECG and focused echocardiographic findings.
  • All athletes screening positive were referred to a cardiologist and eventually cleared for sports participation.
  • No athlete screened positive by focused echocardiography alone.
  • Focused echocardiography was able to reduce the referral rate for hypertrophic cardiomyopathy by 33% and obtained measurements statistically similar to those of formal echocardiography.

Conclusions

This study provides evidence that focused physician-operated echocardiography can improve false-positive rates and broaden the spectrum of disease that is detectable through preparticipation screening of athletes. The focused echocardiography added only an average of 7 minutes to the exam time.

*Study done in collaboration with Eugene S. Yim, MD, MPH and Gianmichel Corrado, MD

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