The clear answer of Roald Bahr, professor in sports medicine, from the Oslo Sports Trauma Research Center is no. Mandatory electrocardiographic (ECG) screening of athletes would detect heart problems and save lives, argue Antonio Pelliccia and Domenico Corrado recently in the British Medical Journal, but Roald Bahr claims that the diagnostic accuracy is questionable.
In Norway, an eight-year review (1990-7) of sudden deaths from the Norwegian Cause of Death Registry found 23 exercise related deaths among 15-34 year olds - that is, an average of three a year. The authors estimate that the population at risk is about 325 ,000, corresponding to 0.9 deaths/100,000 a year, an incidence in the mid-range of rates reported in previous studies.
The implication is that 325,000 Norwegians would need to be screened routinely to save three deaths a year, assuming that everyone at risk can be identified and all deaths prevented. However, this is probably an optimistic estimate, argues Bahr, as the main cause of death in Norway was atherosclerosis, which is difficult to detect on a resting ECG.
Bahr agues that ECG screening of athletes fails accepted public health criteria for screening programs on several counts. Although sudden cardiac death is tragic, it is also rare.
The diagnostic accuracy is low and depends on which cardiac conditions are the main causes of sudden death in the population being screened. Screening of hundreds of thousands of athletes to save possibly only one life a year, as would be the case in Norway, cannot be justified.
Read the head-to-head articles of Antonio Pelliccia & Domenico Corrado and Roald Bahr.
Read André Picard, a public health reporter at the Canadian The Globe and Mail "Screening young athletes: What’s one life worth?"