Diagnostic yield and cost analysis of electrocardiographic screening in Swiss paediatric athletes

OBJECTIVES

Athletes performing sports on high level are at increased risk for sudden cardiac death. This includes paediatric athletes, even though data on screening strategies in this age group remain scarce. This study aimed to assess electrocardiogram interpretation criteria in paediatric athletes and to evaluate the cost of screening.

METHODS

National, multicentre, retrospective, observational study on 891 athletes of paediatric age (<18 years) evaluated by history, physical examination and 12-lead electrocardiogram. The primary outcome measure was abnormal electrocardiogram findings according to the International Recommendations for Electrographic Interpretation in Athletes. The secondary outcome measure was cost of screening.

RESULTS

19 athletes (2.1%) presented abnormal electrocardiogram findings requiring further investigations, mainly abnormal T-wave inversion. These 19 athletes were predominantly males, performing endurance sports with a mean volume of 10 weekly hours for a mean duration of 6 years of training. Further investigations did not identify any relevant pathology. All athletes were cleared for competition with regular follow-up. Total costs of the screening were 108,860 USD (122 USD per athlete).

CONCLUSIONS

Our study using the International Recommendations for Electrographic Interpretation in Athletes identified a low count of abnormal findings in paediatric athletes, yet raising substantially the cost of screening. Hence, the utility of electrocardiogram-inclusive screening of paediatric athletes remains to be elucidated by longitudinal data.

The role of bystander-initiated basic life support in exercise-related sudden cardiac arrest: a systematic review

Background

Sudden cardiac arrest (SCA) is the leading cause of death amongst athletes and a common cause of death during exercise. Although the provision of cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use by bystanders improves outcomes after SCA, the impact of these interventions within exertional settings requires further investigation.

Purpose

The purpose of this systematic review was to evaluate the role of bystander CPR and AED use on survival after exercise-related SCA.

Methods

Literature searches in MEDLINE, EMBASE, PubMed, CINAHL, SPORTDiscus, and Cochrane Library were queried from inception until November 2020 using a comprehensive search strategy. Grey literature searches of Google Scholar and CADTH Grey Matters were also performed. Abstract screening, full-text review, and data extraction of eligible studies was conducted independently by two reviewers, with any conflicts discussed until consensus reached. Eligible studies included observational research studies assessing a population of exercise-related SCAs (defined as an out-of-hospital cardiac arrest which occurred during exercise or within 1-hour of cessation of activity), where the rate of bystander CPR and/or AED use was provided, and survival outcomes were reported. Abstracts, studies with overlapping patient data, and/or studies of n≤10 were excluded. Among studies with similar populations, the overall rates (median, range) of bystander CPR, AED use, and survival outcomes were calculated.

Results

A total of 3,718 records were identified from literature searches, and after removal of duplicates, 2,850 were screened. Among those screened, 176 articles were selected for full-text review, of which 29 studies were included in this review. Majority of included studies were cohort studies (2 case series and 2 cross-sectional), with a median sample size of 91. Most patients who suffered from an exercise-related SCA were male, middle-aged, and presented with a shockable arrest rhythm. The median rate of bystander CPR reported amongst 22 studies was 71% (31%-100%), whereas the median rate of bystander AED use reported amongst 16 studies was 31% (2%-100%) (Table). Among the 19 studies which reported the rate of survival to hospital discharge, survival ranged from 11% to 77%, with a median rate of 32% (Table). Patients who survived to hospital discharge more frequently received bystander CPR and had an AED applied than patients who died (Figure).

Conclusions

Survival rates after exercise-related SCA were higher than previously reported in other settings not related to exercise. These outcomes are likely related to a higher rate of bystander interventions in exertional or sport-specific settings. The findings of this review encourage layperson education in basic life support, the availability of AEDs in exercise facilities, and the development of emergency action plans to provide point-of-performance cardiac care in exertional settings.

Funding Acknowledgement

Type of funding sources: None.