Sunday, November 13, 2011

When Screening Teenage Athletes for Sudden Cardiac Arrest Risk, History Matters

Before reaching for tests like EKGs to screen teen athletes, we should first ask ourselves if we've taken a careful history:
The new study consisted of Madsen and his fellow researchers sending out surveys to every pediatrician and family practice doctor in Washington State. They received a good response–surveys were returned by 72 percent of pediatricians and 56 percent of family practitioners.

The results were disheartening:

  • 28 percent of doctors surveyed failed to always ask if a teen experienced chest pain during exercise.
  • 22 percent of doctors surveyed failed to always ask if the teen ever fainted without a known cause or explanation.
  • 26 percent of doctors surveyed failed to always ask about early deaths in their family history.
  • 67 percent failed to always ask about heart disease in their family history.
Dr. Gaurav Arora, associate director of electrophysiology at the Children’s Hospital of Pittsburgh and an assistant professor of pediatrics at the University of Pittsburgh, was surprised to see the number of physicians in the new study who said they didn’t ask every teen athlete about fainting or chest pain. He said, “Those are red flags in young athletes.”


Tim Hulsey, MD said...

I have mentioned before on this blog that I no longer volunteer for student physicals, because I don't feel competent to rule out these problems. When I do H&Ps on my surgical patients, listening to the carotids is obviously part of it. I have found only one bruit in almost 30 years. Listening for them in children was not part of my normal pediatric H&P... until just a few years ago.
My nephew had had problems occasionally with syncope. This was not exertional, however. He was found to have a loud right neck bruit, and work up found an anomaly in his intra-thoracic great vessels. He has had no further problems, but this has caused me to listen to the carotids even in pediatric patients. It doesn't take much extra time.
Your post does re-inforce what our professors said about history being the most important part of the H&P. Hopefully, we can be re-programmed as easily as Watson to ask those important questions!

Anonymous said...

Dr Husley,

Your nephew had a symptom(repeated syncope) that warranted further investigation.

That does not necessarily imply adding an additional test(listening for bruits) in an asymptomatic patient population at extremely low risk for carotid pathology.

In fact your nephew's case really just reinforces asking about fainting but says nothing about listening to carotids.