• Pre-Participation Screening for Sports


    As a parent, you of course want to do everything you can to protect your child’s health. If your child is about to begin playing a sport and has no known cardiovascular defects, you may wonder if he or she should be screened for heart problems. 

    The American Heart Association (AHA) currently recommends that a detailed physical exam along with a complete and targeted personal and family history for student-athletes is compelling – for ethical, legal, and medical reasons. The incidence of sports-related deaths directly due to cardiac causes appears to be relatively small, yet each of these episodes understandably generates significant media attention. It is everyone’s goal to prevent as many of these rare but tragic events as possible.

    No cardiovascular tests (electrocardiogram, echocardiogram, chest x-ray, or stress testing) are routinely suggested as part of a pre-participation sports screening program in the United States, unlike in some other counties. This is because there are no tests that will definitively diagnose all children and adolescents who may be at risk for a cardiac event. However, a detailed physical exam, along with questions about the participant’s personal and family medical histories, is prudent prior to participation in competitive sports. Additionally, schools are increasingly requiring this type of pre-participation screening by a pediatrician prior to competitive sports involvement.

    Although specific tests, such as an electrocardiogram, echocardiogram, or exercise stress test, can help diagnose some people with heart disease, they are not recommended routinely. A study published in 2009 in Circulation: Journal of the American Heart Association that analyzed 1,866 cases of cardiac arrest resulting in 1,049 deaths in young athletes found that 56 percent of deaths were directly due to cardiovascular disease (versus blunt trauma to the heart, etc.). Of those deaths, screening would have likely identified only 30 percent of abnormalities. Additionally, the study found the individual risk of death was quite low – similar to that of lightning-related deaths. 

    In view of the very low frequency of heart-related athletic deaths, it is very likely that mass diagnostic screening would result in more "false-positive" results than indicate actual heart problems. This would result in many children who would be unnecessarily restricted from sports participation. Furthermore, the psychological stress of being incorrectly diagnosed as at risk for a cardiac event cannot be underestimated.

    If, after a physical exam and detailed medical history of your child, your pediatrician believes that further cardiac evaluation is necessary, a referral to a pediatric cardiologist may be made.