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 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.
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