Athletic screening in children
JAMAICA IS a sports-loving nation. From Sports Day in basic schools to playing football and cricket in open lots, it is in our blood. Sports teaches children not only how to keep fit, but also discipline, time management and team work. As competitive sport participation gets more challenging with age, athletic pre-participation screening should be considered.
WHAT IS SCREENING?
Screening should be sensitive, quick and cheap. In pre-participation screening, it is not necessarily so. An athlete is assessed by a physician to detect the presence of a silent condition that could worsen or lead to the child’s demise by continued sports participation. More specific tests are done depending on the results.
WHAT ARE WE LOOKING FOR IN THE SCREEN?
Structural (heart muscle and blood vessels) and electrical (rhythm) problems of the heart are examined for. Screening also includes checking for muscle and bone abnormalities that can affect performance. Although rare, the risk of sudden cardiac death (SCD) from an undiagnosed condition is increased by 2.5 times in sports. Different reports show that SCD is more common in blacks, males, and in sports such as football and basketball.
WHO SHOULD GET SCREENED?
It is generally accepted that any athlete of high-school or university age who requires systematic training and participates in regular competition is a candidate for screening. However, any athlete of any age with symptoms such as chest pain or heart racing, during or immediately after activities, should be screened.
HOW DO WE SCREEN?
This topic is debated continuously because of the associated high cost and the low yield. In the USA, screening consists of a questionnaire and a physical examination, while in Italy (where a very successful screening programme for the past 25 years exists) it consists of a questionnaire, an examination and an electrocardiogram (ECG).
In Jamaica, it is acceptable to incorporate: i. a questionnaire which asks about symptoms, family history, etc. ii. a physical examination which includes blood pressure measurement, height, weight. iii. an ECG to assess the electrical activity of the heart. The ECG may show obvious abnormalities or it may give clues to problems that are present in the heart.
This screening method is
routinely used for the national swimmers.
WHAT ARE THE IMPLICATIONS?
Being informed that there are no abnormalities is the best news an athlete and family could hear, and this is the case for most athletes. Infrequently, however, screening will detect a problem. This can have financial ramifications as more tests are required to determine the extent of the problem, the risk to the athlete, and there may be a cost in cases where treatment is indicated. Not to be overlooked is the psychological effect. The athlete may have to stop playing the sport they love, scholarship hopes are abandoned, and being labelled ‘sick’ can cause depression.
It is impossible to eliminate all the risks associated with competitive sports; and note that even after a negative screen, there may be other factors such as inflammation of the heart muscle (e.g., with the flu), use of stimulants (such as energy drinks), among others, that can cause lifethreatening heart rhythms.
Let us take our love of sports and our athletes to heart (pun intended) as screening does save lives.