A special theme issue of BJSM guest edited by Jon Drezner and Babette Pluim on the topic of sudden cardiac death in young athletes is scheduled for June 2009.

A letter from Dr. Thamindu Wedatilake, Hope Hospital, Salford, UK, related to this serious sports medicine condition:

I have read in interest the article by Wilson et al regarding their support for using an ECG in screening for sudden cardiac death in the young. Furthermore I note that there is considerable support from many sporting governing bodies for the above recommendation.

I note the comments of Dr Richard Page where he argued that in the USA alone, mass ECG screening of young athletes would exclude 2000 children from sport for every life saved.

Dr. Page’s comments have concerned me. By trying to save one life in an issue that is highly media motivated for the obvious dramatic nature of sudden cardiac death, we prison a further 2000 children to a potentially life threatening sedentary life style. Hence, ironically we may increase their risk of death from a cardiac cause later in life.

Are we really doing whats best for these children or are we dancing to the tune of the media? Have we thought about the long term repercussions that such a screening programme may have on our childrens’ physical and psychological wellbeing?

Yours/your colleagues thoughts are appreciated.

Jon Drezner replies:

Dr. Wedatilake,

You make an excellent point which was also raised by Dr. Page. Interestingly, I just gave a pro/con ECG screening Grand Rounds with Dr. Page and we looked at this question together.

The number of disqualifications and the downstream effect of limiting exercise in a subset of kids (with identified cardiovascular disease) but who may never suffer SCA is a question that needs to be investigated. I would agree that disqualifying 2000 to save 1 life may not be acceptable. What number of disqualifications is acceptable? 1000? 100? 10? I think the number of disqualifications calculated to save one life is hugely affected by 3 things: the incidence of SCD, prevalence of asymptomatic disease, and total positive (and false positive) rate of ECG screening. If you begin with traditional reported estimates (1:200,000 incidence and 15% false positive) you get about 2000 disqualifications. If you use statistics from more recent studies (1:50,000 incidence and 2-5% total positive rate), you get about 30-50 disqualifications to save a life. Unfortunately, these are all just calculations and until we have large scale studies with follow-up of those disqualified, the long-term effects will just be speculative.

Sudden cardiac death has always been at the apex of ’serious’ sports medicine conditions. We all agree that one death is one too many. Sports physicians with expertise in cardiac issues — Jon Drezner and Babette Pluim — will guest edit a 2009 Themed Issue that will include, but not be limited to, original data and commentary on the use of automated external defibrillators (AEDs) in the athletic setting, emergency preparedness for sudden cardiac arrest, and the secondary prevention of sudden cardiac death in young athletes.

We look forward to the opportunity to work with authors, groups convening to provide consensus statements, and partner journals to contribute to minimizing sudden cardiac death in the sporting setting.

This special issue will form the June 2009 Issue of BJSM. More details will follow and the deadline for submissions is 11:00 pm, Dec 31. 2008.

One of the questions that is always asked of sports medicine clinicians is how much training kids should be doing. At a time where physical inactivity is the major childhood disease, we also have the paradox of parents encouraging 3-yr old golfers and 4 yr-old tennis players. After all, the earning potential of those children exceeds the annual salary of all but the most successful CEOs.

Until now, there has been very little to guide training the elite athlete. The IOC Medical Commissionhas a goal of protecting the health of the athlete and to this end, it convened a group to develop a Consensus Statement on the training of the elite child athlete. The paper provides a holistic approach to training the elite child athlete, including exercise prescription, psychological training, nutritional guidelines and special considerations.

It is now available in the March issue of BJSM (Br J Sports Med 2008;42:163–164). The expert committee members were: M Mountjoy, N Armstrong, L Bizzini, C Blimkie, J Evans, D Gerrard, J Hangen, K Knoll, L Micheli, P Sangenis, W Van Mechelen.

What are your thoughts? Is this helpful? How could it be improved? What is your experience with the elite child athlete. Please leave any feedback in the comment section below.