Cardiac Screening

October 31, 2014

The American Heart Association has once again concluded that sophisticated and expensive heart screening is not practical or appropriate as a precondition for youth and young adults to participate in competitive organized sports.
On Sept. 14, 2014, the AHA online publication Circulation stated:

Sudden death among 12 to 25-year-olds is “a low event rate occurrence.”

“There is insufficient information to support the view that ECGs in asymptomatic young people for cardiac disease is appropriate or possible on a national basis for the United States, in competitive athletics or in the general population.”

“At present, there is no mechanism available in the United States to effectively create national programs of such magnitude, whether limited to athletics or including the wider population of all young people.”

“There is insufficient evidence that particularly large-scale/mass screening initiatives are feasible or cost effective within the current US healthcare infrastructure . . .”

“The ECG . . . cannot be regarded as an ideal or effective test when applied to large healthy populations.”

“An additional, but unresolved, ethical issue concerns whether students who voluntarily engage in competitive athletic programs should have advantage of cardiovascular screening, while others who choose not to be involved in such activities (but may be at the same or similar risk) are in effect excluded from the same opportunity.”

The AHA’s Sept. 14 AHA writing group “does not believe the available data support significant public health benefit from using the 12-lead ECG as a universal screening tool. The writing group, however, does endorse the widespread dissemination of automated external defibrillators which are effective in saving young lives on the athletic field and elsewhere.”

It’s a Blizzard

March 18, 2015

Like the good people in Boston and other eastern cities and towns who couldn’t find anywhere to put all the snow they were getting this past winter, those in charge of school sports can’t find anywhere to put all the advice and expertise pouring down on us. We are well beyond the tipping point between too little and too much information regarding concussions.

In one stack before me are different descriptions of concussion signs and symptoms. I could go with a list as short as five symptoms or as long as 15.

In a second stack before me are different sideline detection solutions – tests that take 20 seconds to more than 20 minutes, some that require annual preliminary testing and others that do not.

In a third stack are a variety of return-to-play or return-to-learn protocols, ranging from a half-dozen steps to more than twice that number.

When I read that the National Football League, with all of its resources, was “overwhelmed by all of the expert opinion right now,” I was not comforted.
We have to cut through the clutter and provide our constituents clear and concise recommendations for the efficient education of coaches, student-athletes, parents and others; for electronic sideline detection solutions that are not only quick and effective in assessing injuries but also provide immediate reports and permanent records of concussions; and for protocols that place return to play well behind return to practice and further behind return to learn.