Incidence of Sudden Cardiac Arrest in High School Student Athletes on School Campus
Toresdahl BG, Rao AL, Harmon KG, & Drezner JA. Heart Rhythm. 2014 Published Online First April 11, 2014: doi: http://dx.doi.org/10.1016.j.hrthm.2014.04.017
Take Home Message: Male athletes have the highest risk for sudden cardiac arrest compared with non-athletes. Preventative measures should be targeted to this at-risk population, specifically in higher risk sports such as football and basketball.
Sudden cardiac arrest (SCA) events are catastrophic but yet a debate continues about how we should screen athletes to identify individuals at high risk. Part of the challenge is that we don’t have a good understanding of how often SCA occurs in the athletic population. Therefore, Toresdahl and colleagues investigated the occurrence of on-campus SCA events in a large United States high school student population, both athletic and non-athletic. On-campus SCA events were monitored at 2,149 high schools for approximately 2 academic years. Throughout this time, 26 SCA events were reported in students with 18 SCA cases occurring in student athletes. The overall SCA incidence in high school students on campus was 0.63 per 100,000 students. Among student-nonathletes the incidence was 0.31 per 100,000 students while the incidence rate in student-athletes was 1.14 per 100,000, which illustrated a relative risk that was more than 3 times greater within the student athlete population. Among student-athletes, the risk was 5.65 times higher in males compared with females. Males specifically had a higher incidence of SCA events, with the relative risk drastically greater (almost 5 times greater) among male student athletes compared with male non-athletes. There were 4 total deaths post SCA event, 2 in athletes (male) and 2 in non-athletes (female).
This study illustrates that the incidence of on campus SCA events is higher than originally thought. While most of the included schools required a pre-participation exam prior to athletics, this still is not reducing the risk for SCA events and a more sensitive screening measure may be warranted. Male student athletes appear to be the most at-risk population. Preventative screening measures may need to be emphasized and targeted on male student athletes based on the findings of this study, specifically in higher risk sports such as football and basketball. A vast majority of the schools that were included within this study (87%) had automated external defibrillators (AED), and only 1 of the SCA reporting schools did not have this program. The authors of this study highlight that high AED access may be why there is such a high survival rate post SCA event, and recognize that this may not accurately reflect all high schools across the United States. It would be interesting to see what percentage of high schools nationwide have AED programs as well as look at their response times of AED’s to these SCA events. It may be that the AED access saved many of the lives during the SCA events. It is important to note that this study focused on on-campus event; hence it is probable that the rate of SCA events is higher than reported in this study. It would have been interesting if the authors assessed the occurrence of SCA events among race/ethnicity. Sports Med Res previously reported a study where the authors found that African-American athletes had more sudden cardiac death than white athletes, but their rate of sudden cardiac death was comparable to the general student body of African Americans. Overall, we can use these new findings to further raise awareness about sudden cardiac arrest among high school athletes and the need to have AEDs and to further improve our screening protocols.
Questions for Discussion: Do all of the high schools in your area have access to an AED? Do you think that preventative EKG screenings should be used in high school male athletes since they are at a higher risk?
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban
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Toresdahl, B., Rao, A., Harmon, K., & Drezner, J. (2014). Incidence of sudden cardiac arrest in high school student athletes on school campus Heart Rhythm DOI: 10.1016/j.hrthm.2014.04.017