Pre-participation Screening in Young Competitive Athletes - A Canadian Perspective
Bibliographic record
Abstract
Sudden Cardiac Death (SCD) in young competitive athletes is rare and devastating. SCD in athletes is typically the result of inherited structural and arrhythmic disorders that go undiagnosed. Cardiac screening has the potential to reduce SCD, yet implementation remains a controversial issue. The disparity lies in whether or not a 12-lead electrocardiogram (ECG) should be included in addition to medical history (HX) and physical exam (PE). However, an Italian study reported a 90% risk reduction of SCD that included an ECG. Canada has no official mandate for screening. PURPOSE: To determine the prevalence of cardiovascular disease in young competitive athletes across a variety of sports as well as the effectiveness of different cardiac screening strategies (HX, PE, ECG). METHODS: We examined 386 athletes (78% male, 20 +/- 3.8 years, 72% Caucasian) from various sports. It is our goal to recruit 2000 participants within the next two years. All participants completed American Heart Association (AHA) HX, PE, and ECG. Positive ECGs or an abnormal PE or HX were referred for further investigation. The prevalence of cardiovascular abnormalities related to SCD risk was measured objectively. RESULTS: Of the 386 athletes that were screened 47 (12%) required further evaluation: 5 (1.3%) due to positive PE, 35 (9.1%) due to positive HX, and 7 (2%) due to abnormal ECGs. One athlete has suspected hypertrophic cardiomyopathy (HCM) with genetic testing results pending. Two athletes are still being evaluated; one with query arrhythmogenic right ventricular cardiomyopathy, another for evaluation of a loud systolic murmur. Personal symptoms (chest pain, pre-syncope, dyspnea, palpitations) are the most common cause for follow-up. ECG and/or physical examination identified all three athletes with suspected cardiovascular disease and one also reported symptoms. CONCLUSION: In the 386 athletes screened, 12% required further evaluation. There was one case of probable HCM. This individual did not report any symptoms, nor have a significant murmur on auscultation. In this individual, an abnormal ECG prompted further investigation. The AHA questionnaire produced a high false-positive rate and as such a more sensitive questionnaire is likely warranted. The addition of ECG to standard screening appears to be a prudent step.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".