Resus is the answer, screening inefficient and too expensive for the NHS
Currently a resting ECG costs £35 through CRY. Variable penetrance
for HCM with obstruction, means that one off resting ecg screening will
miss the commnest cause of sudden athletic death in the under 35's unless
it is repeated on up to an annual basis.
Although a combination of family symptoms, family history and resting
ecg will increase the sensitivity of a screening prgramme, upgrading to
stress ECG's and on probably an annual basis just wont work on the NHS due
to cost. Thus by definition such a "screening" programme is by definition
The obvious question is what do we do with the positive screening
tests. Do we truely have a right to prevent participation in sport?
Especially for example, the african runner, who's sporting prowess
provides food and water for his whole village.
The Seattle experience suggests that the availability of advisory
external defibrillators is a positive step in improving survival from
community cardiac arrest.
Thus rather than creating hysteria and false reassurment form a
normal one off ecg for the general population, we should be investing in
improving the resus skills and equipment at venues where athletic activity
is likely to take place.
The 2005 European resus council evidence suggests that early
electricity saves lives.
We need more focus on community defibs and training, rather than
trying to (unreliably) screen the general public and create a nation of
fat people through telling them not to exercise.
Jonathan Hanson Rural Practitioner and sports physician
course author and co-ordinator Scottish Rugby Union Medical cardiac and pitchside skills. (SCRUMCAPS)
Competing interests: No competing interests