Should student athletes undergo comprehensive cardiac screening before taking to the field? National screening standards do not yet exist in the U.S.; current recommendations from the American Academy of Pediatrics (AAP) call only for a physical exam and a careful family history by a health care provider who can recognize heart disease— then for specialized testing in cases that warrant further evaluation. The American Heart Association (AHA) also recommends that high school athletes’ screening be repeated every two years, with an interim history taken in the intervening years.

But some pediatric cardiologists believe this level of screening doesn’t adequately identify risk factors. The International Olympic Committee and the European Society of Cardiology have recommended that young athletes be screened with an EKG, and an AHA consensus panel concludes, “Cardiovascular screening for young competitive athletes is justifiable and compelling on ethical, legal and medical grounds.”

Ideally, every school-age competitor should have the highest level of screening, but critics note the dilemma of ballooning health care costs and ask how the U.S. can apply a realistic, effective prescreening process in our huge population. And they wonder about the 9 percent false-positive rate that the Europeans have found; in the U.S., that would mean 1,999 false-positives for every young athlete detected with a problem.

Some communities have confronted the dilemma head-on. In Illinois, a foundation under the guidance of cardiologist Joseph Marek, M.D., has screened 20,000 students. With the help of high schools, community volunteers and volunteer cardiologists, the Midwest Heart Community Foundation administered three-minute, painless, noninvasive EKGs, analyzed test results and notified nearly 400 families of abnormal EKG results that needed further evaluation. Several students with life-threatening conditions were also identified. —M.E.S.