Should EKG tests be included in sports physicals?

2013-12-17 14:42:19 by Dr. Joe Congeni - Director of Sports Medicine, as posted on the inside.akronchildrens.org blog.

Photo by UNN / Flickr CC Photo by UNN / Flickr CC

We discussed last week that itís time for pre-season sports physicals. However, this year, thereís a raging debate about whether all kids should get an EKG in their physical to help prevent sudden cardiac deaths.

Today, I had the chance to talk with WAKR host Ray Horner about this topic.

The debate brings up concerns about cost and false positives with the test. At this time, thereís no strong recommendation to include an EKG in your physical, but it is being watched and studied very closely this year.

Below is an audio file and transcript of our discussion.



Horner: Letís bring in our good friend, Dr. Joe Congeni from Sports Medicine Center at Akron Childrenís Hospital. Good morning, Joe.

Dr. Congeni: Hey, Ray. How are ya?

Horner: Iím doing well. Good to have you back from vacation.

Dr. Congeni: Good. Thanks. I love being back here.

Horner: Ah, okay. What do you have for us today?

Dr. Congeni: Well, you know, we said last week weíre gonna finish up on the routine issues related to the pre-sports physical. This is the time of year to get it done, so thereís plenty of time to follow up.

But, I mentioned that thereís also a big controversy brewing for the first time in 20, 30 years with the sports physicals.

Everybody had always said with the sports physical that just doing the history and the physical alone ó no lab work, no testing or anything further ó . But, whatís happened in the last year, thereís been a lot of study about whether we should do an EKG on everybody playing sports. Thatís really a big deal.

Dr. Joe Congeni Dr. Joe Congeni

You know, a lot of people nationally in sports medicine circles have said, weíve spent so much time paying attention to concussion in the last 5 years ó because thereís so many questions and so many unknowns ó that maybe weíve taken the eye off the ball a little bit in the things that really lead to sudden death in sports, and thatís heat and heart.

From the standpoint of heart problems that lead to sudden death in this country in athletes, less than age 30, Ray, thereís about 10 to 25 kids per year in this country who have a heart problem and when they are playing sports, they end up going down into cardiac arrest and dying.

And when that happens in a community ó and weíve had our share in Akron in the last 25 years ó itís devastating. When a kid goes to practice totally healthy and ends up being dead that day, thatís devastating.

So the question is can we do a good job at the time of the physical?

The problem with the heart issues that lead to sudden cardiac death, many of them have no symptoms. donít have chest pains, they donít have passing out. Many times the first symptom a kid will have will be sudden death.

And the second issue is thereís not much in the examination that we pick up. Many times they wonít have a murmur. Theyíll have a normal exam and you canít pick it up on a routine physical exam.

So, the call lately has been for looking at possibly doing EKGs on everybody who plays sports, and thatís a big deal.

Hereís the reasons itís a big deal:

No. 1, cost. Thereís about 7 million kids who play high school sports in this country. And if all of them had testing done ó thereís about 800,000 that play college sports ó thereíd be an increased cost.

Now, for years we said the echo (echocardiogram), the test that actually shows the chambers of the heart, was necessary. That test was out of sight; thatís a $2,000 test. We canít do that on everybody, but you can do an EKG for $50 to $150.

No. 2, if you do EKGs on everybody, youíre going to pick up a lot of people that have normal variations from being high-level athletes. Then, youíre going to be chasing a lot of other issues to see if itís real or not. We get a lot of what are called false positives.

Well, in 2013, a group met and said that if you have specific, strict criteria about whatís abnormal and whatís normal, EKGs can be cost effective.

So, finally, to wrap it all up, right now as of 2013, there is no strong recommendation that everybody has to have an EKG for the sports physical. But, it is being watched very closely this year.

There are a few studies going on in parts of the country. And Ö right now, I think parents have the right to say that theyíd like to have that test done on their kid to find out if they could be one of those needle-in-a-haystack kids that would be at risk for sudden cardiac death.

Horner: Joe, I know there are a number of schools in the area that are having groups come in to different practices and giving the players and the families those options of getting the tests done.

Dr. Congeni: They are doing it even in the mass screening physicals. There are several schools in our region that are offering that. Now, Iíve seen a few of those, Ray, and itís a lot more than that $50 to $150 that I was talking about.

And, also, is everybody using these new criteria that are known as the ďSeattle Criteria? Ē Otherwise, upwards of 25 percent of kids can have whatís called an abnormal EKG, but itís not really abnormal to cause one of these things that causes sudden death.

So, the big thing Iím hoping there is that people arenít just trying to make money off this deal. And No. 2, Iím hoping that people are using the right criteria so that 25 percent of the kids donít come up with whatís being called abnormal in their heart.

Horner: Alright, Joe. Good information as always. Weíll catch up with you next week.

Dr. Congeni: Alright, Ray. Have a great week.

Horner: You too. Dr. Joe Congeni, Sports Medicine Center at Akron Childrenís Hospital, with us.

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