Several studies in the first of a series of quarterly partnership issues between the British Journal of Sports Medicine and the International Olympic Committee (IOC) are dedicated to injury prevention in elite sports. They report that young athletes should be routinely tested for heart abnormalities. This is to prevent sudden cardiac death that is triggered by vigorous exercise, using a simple protocol, which includes a heart trace, such as an electrocardiogram or ECG.
The leading cause of death in young athletes is sudden cardiac death. However it is unclear how frequently it occurs since figures vary significantly and there is no mandatory reporting.
There has been considerable debate on the subject of preparticipation cardiovascular screening (PPS). It is the screening for silent but potentially deadly heart abnormalities in athletes before they embark on a career in competitive sports.
The publication of a common European protocol, known as the Lausanne recommendations, restarted the debate in 2005. The recommendations promote recording personal and medical history, a physical examination, and an ECG for every young competitive athlete.
But there is argument that there are too many variations between countries for these recommendations to be universally applicable. In addition, the ECGs pick up too many ‘normal irregularities’ induced by the body’s adaptation to the demands of competitive sports and as a result spark unnecessary alarm and needless investigations.
Critics have also suggested there is doubt on the cost effectiveness of this check.
In this special issue, Dutch researchers published their findings answering to the critics in some ways.
Over a period of two years, the researchers applied the recommendations to 371 athletes. They were all between the ages of 12 and 35. They found that their findings corroborated earlier research carried out on Italian athletes, over a period of 25 years.
The results indicated that ECG produced false positive results for 47 athletes (11%). Also, it picked up problems in a additional 10 (2%), of whom four were restricted from further participation in sport. The authors say: “The number of screens needed to pick up one athlete with potentially lethal cardiovascular disease was 143, which is well within acceptable limits for any screening programme.”
In another evaluation of the existing evidence, British researchers confirm that attempting to pick up potentially fatal heart abnormalities through questionnaires and physical exam alone is not very efficient.
Research shows the use of defribillators at an event is not a viable alternative either, because the survival rate is so low.
If a cardiologist carries out an ECG check, the false positive rate can be as low as 2%. On the other hand, a well organized national programme would be cost effective, they argue, “especially when considering the devastating effect of a sudden death in a young athlete.”
The Lausanne recommendations have already been endorsed by the football governing bodies. The Union of European Football Associations also advocates obligatory screening of all players participating in European championships.
The authors write in conclusion: “Healthcare governing bodies need to be convinced that now is the time for universal ECG screening of all young athletes and make the necessary provisions for nationwide screening programmes to commence.”
“The Lausanne recommendations: a Dutch experience”
B Bessem, F P Groot, W Nieuwland
Br J Sport Med 2009; 43: 708-15
doi:10.1136/bjsm.2008.056929
“Electrocardiographic screening in athletes: the time is now for universal screening”
M Papadakis, S Sharma
Br J Sports Med 2009; 43: 663-8
doi:10.1136/bjsm.2008.054874
“Prevention of sudden cardiac death in athletes: new data and modern perspectives confront challenges in the 21st century”
Jonathan Drezner, Babette Pluim, Lars Engebretsen
Br J Sports Med 2009; 43: 625-6
doi:10.1136/bjsm.2009.064592
British Journal of Sports Medicine
Written by Stephanie Brunner (B.A.)