All children, regardless of their athletic status, should be screened for risk of cardiac arrest, the American Academy of Pediatrics said in a policy statement Monday. The group included four questions to incorporate into the screenings, including two pertaining to family history of heart issues.
"The unexpected death of a seemingly healthy child is a tragedy not only for the family but for the family community as well," the AAP said in a statement regarding the policy, which will be published in the July issue of Pediatrics. "Multiple studies have looked at sudden deaths in young people either as a whole or by individual disease processes. However, most of these studies are published in cardiology journals. The goal of the AAP-PACES policy is to present expanded information to pediatricians and other primary care providers."
The guidelines suggest screening for sudden cardiac arrest (SCA) and sudden cardiac death (SCD) should be performed during the preparticipation physical evaluation or at least every three years or on entry into middle/junior high school and high school. In addition to family history, the group recommends physicians inquire about fainting, passing out, or unexplained seizures without warning, especially during exercise, or in response to loud noises such as doorbells, alarm clocks and telephones, or if a patient has ever had exercise-related chest pain or shortness of breath.
"Realizing that primary prevention methods are less than perfect, the policy soldiers secondary prevention, including the creation of a cardiac emergency response plan for schools and the role of the primary care provider as an advocate for CPR and automated external defibrillator training. It also provides information on the family evaluation following a cardiac arrest/death, including addressing bereavement, autopsies and genetic testing. Lastly, there is a section for survivors of cardiac arrest on returning to activity after recovery."
The group also advises that an ECG be the first test ordered when there is concern for SCA risk.