Pre-sports participation CV screening most accurate in children aged 12 years or older
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Key takeaways:
- Pre-sports participation screening for risk for sudden cardiac arrest or death was more efficient at age 12 to 15 years than at age 8 to 11 years.
- The results could inform age-based screening strategies.
When children aged 8 to 15 years were screened for risk for before participating in sports, the diagnostic yield for identifying those at risk was higher in those aged 12 years or older, researchers reported.
“Our study showed that the incidence of sudden cardiac arrest or death was low in children aged 8 to 11 years and increased in those aged 12 to 15 years,” Francesca Graziano, MD, from the department of cardiac, thoracic and vascular sciences and public health, at the University of Padua, Padova, Veneto, Italy, and the department of sports medicine, Semmelweis University, Budapest, Hungary, and colleagues wrote. “In parallel, the yield of pre-participation screening was higher and the costs per diagnosis lower in those 12 years. These findings may have practical implications for designing pre-participation screening programs for children engaged in sports activities. Our data support that after the age of 12 years, pre-participation screening should be performed on all athletes and repeated periodically (perhaps annually) for identification of newly developed cardiomyopathies which have an age-related phenotypic penetrance.”
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Graziano and colleagues assessed the results of annual pre-participation screening in 25,251 competitive athletes aged 8 to 15 years who underwent 58,185 evaluations in Padua, Italy. They also obtained data on the incidence and causes of sudden cardiac arrest or sudden cardiac death for CV causes among children aged 8 to 15 years in the Veneto region of Italy from 2011 to February 2020.
Sudden cardiac arrest or death
During the study period, there were 26 cases of sudden cardiac arrest or sudden cardiac death for CV causes among children aged 8 to 15 years in the Veneto region, six in athletes and 20 in non-athletes, the researchers wrote, noting the incidence rate in both groups was 0.7 per 100,000 children per year. Among those children, four of the six athletes survived but only one of the 20 non-athletes did.
None of the athletes who had sudden cardiac arrest or sudden cardiac death had structural diseases potentially identifiable by pre-participation screening, Graziano and colleagues wrote.
All six of the athletes were aged 12 years or older, as were 17 of the 20 non-athletes. The incidence rate of sudden cardiac arrest or sudden cardiac death was 0.2 per 100,000 children per year in those aged 8 to 11 years and 1.3 per 100,000 children per year in those aged 12 years or older, according to the researchers.
Pre-participation screening identified 26 new diagnoses of CVD conferring risk for sudden cardiac arrest or sudden cardiac death, and such diagnoses were more common in children aged 12 years or older (0.06% per evaluation) than in children aged 8 to 11 years (0.02% per evaluation; P = .02), Graziano and colleagues found.
Among athletes with negative pre-participation screening, two had unexplained sudden cardiac arrest or sudden cardiac death during the study period, one while exercising, the researchers found.
AED access also important
“We found that a sizeable proportion of pediatric victims of sudden cardiac arrest or death showed a structurally normal heart and in most cases the event remained unexplained and could not have been identified by pre-participation screening,” Graziano and colleagues wrote. “Given a law mandating the presence of an automated external defibrillator at all sporting venues, two-thirds of athletes suffering sudden cardiac arrest or death were successfully resuscitated. These observations serve as a reminder that early access to defibrillation should always complement pre-participation screening as a comprehensive strategy against sudden cardiac death in athletes.”
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