New Recommendations Aim to Improve Screenings for Sudden Cardiac Death in Student Athletes

Heart, stethoscope and EKG

Researchers from Seattle Children’s & UW find few doctors follow American Heart Association guidelines

New research by doctors at Seattle Children’s Hospital and the University of Washington has discovered that the majority of physical evaluations of student athletes in Washington State fail to adequately screen for Sudden Cardiac Death (SCD). Only six percent of doctors follow the guidelines set forth by the American Heart Association, and the study could not find a single school that was in full compliance.

Just as troubling, less than half of physicians/providers, and only six percent of athletic directors, were even aware the guidelines exist. Notably, 28 percent of providers do not always ask about exertional chest pain, and 26 percent do not always ask about family history of premature death.

"Despite national guidelines that have existed unaltered for 15 years, these recommendations still have not reached the bedside concerning the screening of athletes for SCD risk factors," said Nicolas Madsen, MD, MPH, pediatric cardiology senior fellow at Seattle Children’s and principal investigator of the study. Jack Salerno, MD, also of Seattle Children’s, and Jonathan Drezner, MD, of the University of Washington co-authored the study.

Six to seven million students nationwide are screened each year using the Preparticipation Physical Evaluation (PPE) before they can try out for or play a team sport, with 165,000 high school athletes in Washington State alone. The exam was instituted primarily to spot risk factors for SCD, but encompasses an overall check of an athlete’s health and well-being, with assessments of not only the heart, but the musculoskeletal system, vital signs, and detailed questions about medical history.

The research team identified a low-cost way to improve the quality of these exams: institute a standardized form containing all 12 components of the AHA guidelines. Currently, the Washington Interscholastic Activities Association (WIAA), the governing body charged with regulating all school sporting activities, distributes a form that includes just eight of these guidelines, and many schools use their own form. Based on the team’s research, the WIAA recently voted to mandate the use of a more complete standardized form, which physicians and schools are to begin using starting in the 2012-2013 academic year.

Reliable data for the number of deaths attributed to SCD is hard to come by, but recent studies suggest it is most likely between 1 in 40,000 to 1 in 50,000 people. “While rare, when a young person dies due to SCD, it’s devastating to their family, school and community. We believe more thorough screenings can potentially prevent some of these premature deaths by identifying students with serious heart conditions and keeping them off the field,” Dr. Madsen said. “This form will also help us collect more reliable data so we can better understand how widespread the condition is in our state.”

Dr. Madsen also added that parents of student athletes can educate themselves about the examination, and what should be checked, by visiting

The study’s findings were first presented in November at the American Heart Association’s Scientific Sessions 2011 conference in Orlando.

About Seattle Children’s

Consistently ranked as one of the best children’s hospitals in the country by U.S. News & World Report, Seattle Children’s serves as the pediatric and adolescent academic medical referral center for the largest landmass of any children’s hospital in the country (Washington, Alaska, Montana and Idaho). For more than 100 years, Seattle Children’s has been delivering superior patient care while advancing new treatments through pediatric research. Seattle Children’s serves as the primary teaching, clinical and research site for the Department of Pediatrics at the University of Washington School of Medicine. The hospital works in partnership with Seattle Children’s Research Institute and Seattle Children’s Hospital Foundation. For more information, visit or follow us on Twitter or Facebook.