Boston Children’s Launches New Sports Medicine Physical

The new 'focused ultrasound exam' accurately identifies at-risk athletes, study says.

Unfortunately, you see it on the news all the time: A young athlete in seemingly excellent health suddenly dies from a previously undetected cardiovascular condition such as hypertrophic cardiomyopathy. The reason why you see it often is because in U.S., it happens in nearly every state annually, according to Boston Children’s Hospital.

These conditions can be detected using electrocardiography (ECG) during a screening exam, but the American Heart Association says that ECGs carry a very high false-positive rate. But if physicians limit screenings to just collecting health history and conducting a physical, that usually fails to identify at-risk athletes. “The sports medicine physical lacks an effective way of ferreting out these heart problems,” says Dr. Gianmichel Corrado, from Boston Children’s Hospital’s Division of Sports Medicine.

That is, until now.

According to researchers, adding an inexpensive ultrasound exam to the routine sports medicine physical could help identify athletes with these conditions.

Corrado and colleagues created a new protocol called the Early Screening for Cardiovascular Abnormalities With Pre-participation Echocardiography (ESCAPE). It adds a two-minute focused ultrasound exam to the regular sports medicine physical. The study, published January 22 in the Journal of Ultrasound in Medicine, showed that the new system can reduce the false-positive rate and detect cardiovascular conditions responsible for sudden cardiac death.

According to a report from Boston Children’s Hospital:

The researchers enrolled 65 male collegiate athletes, aged 18 to 25 years, in their study. Sports medicine physicians screened participants with a history and physical exam, ECG, and focused echocardiography. ECGs were positive in three athletes, but the focused ultrasound exams were normal. Another three athletes screened positive during the history and physical but were cleared both by ECG and focused ultrasound.

The study’s findings indicate that a focused ultrasound, “could address the false-positive issue without adding significant time or cost to the sports medicine physical,” the report says.

The report also says that ECG false-positives are problematic from multiple perspectives.

Athletes who screen positive, approximately 10 percent of the population, must be held out of sports and referred to a cardiologist for additional tests to assess any possible underlying condition. Yet sudden cardiac death among athletes is miniscule among athletes, with estimates of incidence ranging from 1 per 23,000 to 1 per 300,000 worldwide.

“The ESCAPE protocol provides peace of mind. We’ve shown it can easily be part of the pre-participation physical. It could be the sports medicine physical of the future,” Corrado says.

The next step, researchers say, is to launch a multi-center study with the goal of actually finding the needle in the haystack—the athlete with an undetected cardiovascular condition.