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

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.”

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

Seattle Children’s Hospital, Foundation and Research Institute together deliver superior patient care, advance new discoveries and treatments through pediatric research, and raise funds to create better futures for patients. Consistently ranked as one of the top 10 children’s hospitals in the country by U.S. News & World Report, Seattle Children’s Hospital specializes in meeting the unique physical, emotional and developmental needs of children from infancy through young adulthood. Through the collaboration of physicians in nearly 60 pediatric subspecialties, Seattle Children’s Hospital provides inpatient, outpatient, diagnostic, surgical, rehabilitative, behavioral, and emergency and outreach services to families from around the world.

Located in downtown Seattle’s biotech corridor, Seattle Children’s Research Institute is pushing the boundaries of medical research to find cures for pediatric diseases and improve outcomes for children all over the world. Internationally recognized investigators and staff at the research institute are advancing new discoveries in cancer, genetics, immunology, pathology, infectious disease, injury prevention, bioethics and much more.

Seattle Children’s Hospital and Research Foundation and Seattle Children’s Hospital Guild Association work together to gather community support and raise funds for uncompensated care, clinical care and research. The foundation receives nearly 80,000 gifts each year, from lemonade stand proceeds to corporate sponsorships. Seattle Children’s Hospital Guild Association is the largest all-volunteer fundraising network for any hospital in the country, serving as the umbrella organization for 450 groups of people who turn an activity they love into a fundraiser. Support from the foundation and guild association makes it possible for Seattle Children’s care and research teams to improve the health and well-being of all kids.

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