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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.

Tendinopathy Theme Issue of BJSM

Following the success of the tendinopathy issue in 2007, BJSM will publish ‘Tendinopathy Theme Issue’ in 2009. This edition will concentrate on clinical perspectives of diagnosing and managing tendinopathy.

Specifically, we are looking for papers that have direct or inferred clinical application that will help clinicians manage patients with tendon injury. We encourage you to submit original papers as well as novel opinion pieces based on clinical experience and scientific evidence.

Submissions close August 15th, 2008

Enquiries to Jill Cook: jill.cook@deakin.edu.au

Special The Issue of BJSM – Guest editor - Professor Steven Blair

Leading international authors have agreed to contribute to this issue as part of the battle against physical inactivity. This is a terrific opportunity for you to publish your original research alongside wonderful perspective pieces from these authors. Any questions, feel free to email editor Karim Khan - karim.khan@ubc.ca.

Rationale — Why a special theme issue?

Research on the health benefits of regular physical activity has accumulated rapidly over the past few decades. There is now compelling evidence that physical activity has substantial health benefits for all. Physical activity prevents many of the major chronic diseases, delays loss of functional capacity, and extends longevity. The benefits of physical activity accrue to the young, adults, and older adults; to people with chronic disease and those who are healthy; and to people of all sizes and shapes.

Despite the now overwhelming evidence for the health benefits of physical activity, we have been slow to develop and implement broadly based public health strategies to increase and maintain activity in the population. One notable area of concern is clinical medicine, where, despite lipservice, physical activity interventions are rarely prescribed. To rectify this problem, we encourage clinicians to pay more attention to promoting physical activity during patient consults.This special issue of the BJSM reviews the current state of the science and provides practical recommendations as to how clinicians can implement effective physical activity interventions.Deadline for submissions to this issue: 1st August, 2008.