The death of a Michigan teenage basketball player has renewed questions about what kind of heart checkup young athletes need to make the team, and a new study may influence that debate.
Cardiac arrest, when the heart abruptly stops beating, is very rare in young people, especially among healthy young athletes.
When it does happen — like last month when high schooler Wes Leonard collapsed minutes after a game-winning shot in Fennville, Mich. — the deaths make big headlines.
The recurring debate is over whether to add routine EKGs to young athletes' pre-sports checkups. The goal is to find those at risk because of underlying heart conditions before strenuous exertion triggers trouble.
Just how rare is cardiac arrest among young athletes? There's no official count. Estimates range from about 66 deaths a year to more than 100 among athletes under age 40.
University of Washington researchers took a closer look NCAA athletes only. They tracked an NCAA database of athlete deaths, news media reports and insurance records.
They uncovered 45 heart-related deaths over five years among these elite student-athletes, an average of nine a year.
The risk equates to one death among roughly every 44,000 NCAA athletes, Dr. Kimberly Harmon, a University of Washington sports medicine specialist, reported Monday in the journal Circulation.
She found the risk highest among basketball players, followed by swimmers.
"The question becomes, do we need to do a better job at finding who these kids are," says Harmon, who would like both college and high school athletes to receive an EKG screening.
"I don't think that's all that rare," adds co-author and fellow University of Washington associate professor Dr. Jonathan Drezner. "Young athletes are not supposed to die doing what they love."
The American Heart Association recommends a thorough physical exam and detailed family and personal medical history for every athlete, but not an automatic EKG. The idea is to look for red flags — like fainting episodes, a heart murmur or whether a relative died young of a heart problem — that would prompt the doctor to order further cardiac testing.
In contrast, the European Society of Cardiology and the International Olympic Committee recommend the addition of EKGs — electrocardiograms, which measure a heart's electrical activity — to pre-sports checkups.
Mandating EKGs, which can cost $25 to $100, for millions of U.S. high school and college athletes isn't practical, says Dr. Barry Maron of the Minneapolis Heart Institute Foundation, who helped develop the AHA guidelines.
They don't detect all the problems that can lead to those deaths, says Maron. The new study couldn't tell the causes of players' deaths, just that they were heart-related. Then there's the ethical question of testing only athletes when youths not in organized sports sometimes die of these same heart conditions.
"Each and every sudden death is of course tragic," says Maron. But, "they're just not that common."
Moreover, EKGs can falsely signal a problem that requires more costly testing to rule out. A study published last year found 16 percent of routine athlete EKGs were those so-called false-positives.
Maron says sports physicals don't always include all the guideline-recommended questions that would flag someone who needs more intense screening.
A study from Italy a few years ago reported a drop in athletes' sudden cardiac deaths after that country began mandating exams that include an EKG. Last month, a study from Israel found no change from adding EKGs.
Some U.S. colleges have begun recommending an EKG for all their athletes, and parent organizations sponsor community screenings, too.
At the University of Washington, Harmon says adjusting the tests to an athlete's somewhat different readings means that only 5 percent falsely indicated a problem.
The University of Georgia gives incoming athletes both an EKG and a more expensive echocardiogram, an ultrasound exam that can detect different problems. Typically one or two students a year have some abnormality detected, often treatable ones, says sports medicine director Ron Courson, a spokesman for the National Athletic Trainers Association.
But a good medical history is "still the most important thing," he says.
So is having defibrillators at all sports venues and plenty of staff trained to use them, Courson contends. "That way, if you do have something, you're prepared to deal with it," he says.