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The trouble with doing EKGs on athletes

Posted by Dr. Claire McCarthy  May 16, 2012 03:57 PM

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It seems like we hear all the time about another young athlete dying suddenly in the midst of a game or practice. These stories are so scary -- because almost always, as far as anyone knew, the kid was healthy. It's every parent's nightmare.

So when people start talking about screening all athletes with an EKG to look for problems that might cause sudden death, our first reaction is: of course! Let's do it! Make my kid first!

But is it really a good idea? According to an article and editorial in this month's edition of Circulation (the journal of the American Heart Association), the answer may be no.

Screening is really different from going to the doctor because you are having some kind of problem. With screening, you are testing everyone. Before you do any test on a whole lot of people, there are some important questions to ask about the test:
  1. Will it catch the people we want to catch?
  2. Will it catch too many people?
  3. Can anything bad happen because of the screening?
  4. Can we afford it?
When you ask these questions about ECG screening of athletes, the answers are interesting.

Will it catch the people we want to catch? Yes -- and no. The most common causes of sudden cardiac death are hypertrophic cardiomyopathy (HCM), an arrhythmia called Wolff-Parkinson-White Syndrome (WPW), and another arrhythmia called Long QT syndrome (LQTS). Doing an EKG will catch these -- but it may not catch hypertrophic cardiomyopathy if  the EKG is done before the hypertrophic myopathy develops.
 
Will it catch too many people? Absolutely. First of all, it's really common for normal, healthy people to have abnormalities on their EKG. Usually we can figure out that it's not a real problem, but there are usually more tests and some anxiety involved. And just because someone has WPW or LQTS doesn't mean they are going to die suddenly on the playing field. So by doing this test we are going to find things that may not affect a person's health or life at all.
 
Can anything bad happen because of the screening? Yes. Some of the further tests and treatments for HCM or WPW or LQTS have risks -- and when some of the people found on screening may end up being fine or having a minimal chance of having a problem, we need to be thoughtful about those risks. There's also all the anxiety involved in having a result that may or may not mean anything. And with an epidemic of obesity here in the US, it would be a shame if we scare people who are safe to exercise out of exercising.
 
Can we afford it? Probably not. The EKG isn't all that expensive a test, but when you add in the cost of having a doctor read it, and think about screening thousands of kids, well, it adds up. But you also have to add in the costs of the further tests that are necessary if the EKG shows anything (many of which will end up being normal). The authors of the study, from Tufts and Boston Children's, did the math and figured out that if you screen all athletes when they are 14 years old, it will end up costing $91,000 for every year of life saved. That means that if you screen an athlete at 14, find a problem that was going to kill him, and he lives another 60 years, it will cost $5,460,000.
 
Now I'm pretty sure that we all think that our childrens' lives are worth that much. But that's an awful lot of money. And really, if we're going to do it we should screen all kids, not just athletes. Just because a kid doesn't play on a team doesn't mean they don't play pickup basketball or kick a soccer ball around the backyard. If we screen more people, the costs go up.
 
The thing is, there are ways to spend that money that would save more lives. Motor vehicle accidents and suicide are far more likely to kill adolescents than sudden cardiac death. The obesity that starts in childhood is going to shorten many, many lives. If we put the money into preventing these things, we'd have a much bigger impact.
 
That doesn't mean there isn't anything we can do. Every athlete should get a pre-participation check-up that includes a really thorough history (including a thorough family history) and examination. Getting more people trained in CPR, and having defibrillators available at athletic events, can save lives too.
 
Our knowledge about medicine grows every day; there is so much we can do now, and that, while wonderful, means we have some tough decisions to make. Just because we can do something doesn't mean we should.
This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About MD Mama

Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »

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