Should EKG tests be included in sports physicals?

Photo by UNN / Flickr CC

Photo by UNN / Flickr CC

We discussed last week that it’s time for pre-season sports physicals. However, this year, there’s 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, there’s 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: Let’s bring in our good friend, Dr. Joe Congeni from Sports Medicine Center at Akron Children’s Hospital. Good morning, Joe.

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

Horner: I’m 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 we’re gonna finish up on the routine issues related to the pre-sports physical. This is the time of year to get it done, so there’s plenty of time to follow up.

But, I mentioned that there’s 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 — no lab work, no testing or anything further — [was sufficient]. But, what’s happened in the last year, there’s been a lot of study about whether we should do an EKG on everybody playing sports. That’s really a big deal.

Dr. Joe Congeni

Dr. Joe Congeni

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

From the standpoint of heart problems that lead to sudden death in this country in athletes, less than age 30, Ray, there’s 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 — and we’ve had our share in Akron in the last 25 years — it’s devastating. When a kid goes to practice totally healthy and ends up being dead that day, that’s 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. [Kids] don’t have chest pains, they don’t have passing out. Many times the first symptom a kid will have will be sudden death.

And the second issue is there’s not much in the examination that we pick up. Many times they won’t have a murmur. They’ll have a normal exam and you can’t 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 that’s a big deal.

Here’s the reasons it’s a big deal:

No. 1, cost. There’s about 7 million kids who play high school sports in this country. And if all of them had testing done — there’s about 800,000 that play college sports — there’d 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; that’s a $2,000 test. We can’t do that on everybody, but you can do an EKG for $50 to $150.

No. 2, if you do EKGs on everybody, you’re going to pick up a lot of people that have normal variations from being high-level athletes. Then, you’re going to be chasing a lot of other issues to see if it’s 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 what’s abnormal and what’s 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 … right now, I think parents have the right to say that they’d 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, I’ve seen a few of those, Ray, and it’s 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 “Seattle Criteria? ” Otherwise, upwards of 25 percent of kids can have what’s called an abnormal EKG, but it’s not really abnormal to cause one of these things that causes sudden death.

So, the big thing I’m hoping there is that people aren’t just trying to make money off this deal. And No. 2, I’m hoping that people are using the right criteria so that 25 percent of the kids don’t come up with what’s being called abnormal in their heart.

Horner: Alright, Joe. Good information as always. We’ll 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 Children’s Hospital, with us.

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About Dr. Joe Congeni - Director of Sports Medicine

Dr. Joe Congeni is the Director, Sports Medicine; Clinical Co-Director, Center for Orthopedics and Sports Medicine at Akron Children's Hospital. For the past 25 years, Dr. Congeni has been the “go to” source for national and local media looking for information about pediatric sports medicine.

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