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MD MAMA

Is EKG screening for all young athletes a good idea?

Excerpted from the MD Mama blog on boston.com.

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.

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

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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.

Before you do any test on a whole lot of people, there are some important questions to ask:

Will it catch the people we want to catch? Yes — and no. The most common causes of sudden cardiac death are hypertrophic cardiomyopathy, an arrhythmia called Wolff-Parkinson-White Syndrome, and another arrhythmia called Long QT syndrome. Doing an EKG will catch these — but it may not catch hypertrophic cardiomyopathy if the EKG is done before the problem 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 an abnormality 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 have risks. There’s also all the anxiety involved in having a result that may or may not mean anything.

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Can we afford it? Probably not.

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. There are ways to spend that money that would save more lives. Car accidents and suicide are far more likely to kill adolescents than sudden cardiac death.

That doesn’t mean there isn’t anything we can do. Every athlete should get a pre-participation checkup. Getting more people trained in CPR, and having defibrillators available at athletic events, can save lives, too.

As our knowledge about medicine grows every day. we have some tough decisions to make. Just because we can do something doesn’t mean we should.

Dr. Claire McCarthy is a pediatrician at Boston Children’s Hospital. Read more from her blog at boston.com/lifestyle/health/mdmama.

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