Heart Screens for Kids Not Ready for Prime Time

Print This  Email this

By Amy Norton

NEW YORK (Reuters Health) Mar 12 - Routine electrocardiography in children could detect some cases of potentially fatal heart problems, but with many false-positives along the way, a new meta-analysis study suggests.

Children and teenagers are at very low risk of potentially fatal heart disorders. But whenever a young person dies suddenly of cardiac arrest, it's a shock -- and often widely publicized, especially deaths among young athletes.

"There's been this debate about whether ECG screening would be practical and effective in preventing these tragic deaths," said Dr. Laurel Leslie of Tufts Medical Center in Boston, the senior researcher on the new study.

Some countries, including Italy and Israel, already have mandatory EKG screening for young athletes. The U.S. is not one of them

There have also been questions about whether EKG screening could be a good idea in kids being prescribed stimulants for attention-deficit hyperactivity disorder -- though that is not currently recommended.

One of the prime arguments against such screening is that heart disorders that are detectable by EKG are so rare in kids that the risk of false-positives outweighs the potential benefits.

For the new study, published March 5th in Pediatrics, Dr. Leslie and her colleagues analyzed the potential effectiveness of routinely screening symptom-free kids for three heart disorders: hypertrophic cardiomyopathy, long QT syndrome and Wolff-Parkinson-White syndrome.

The three conditions, while rare, are the most common EKG-detectable causes of sudden cardiac death in kids, said Dr. Angie Mae Rodday of Tufts, who also worked on the study.

Using data from 30 studies on the heart conditions, the researchers found that EKG screening would have a very low risk of false negatives. But it would carry a high risk of false positives. Even under the best scenario the researchers considered, 59% of kids with a positive EKG screen would, in fact, not have any of the three heart conditions.

"That's related to the fact that these are rare disorders," Dr. Rodday said.

Based on the studies the researchers reviewed, the three heart conditions together occur at a rate of 188 cases for every 100,000 kids.

Sudden death from heart problems is rarer still. In the U.S., estimates range from less than one to about six such deaths for every 100,000 children and teens.

This study is just one step in considering whether routine EKG screening is worthwhile, Dr. Rodday said.

There's also logistics -- like who would do all of that screening? Some pediatricians have EKG devices in their offices. "But some of these disorders are pretty hard to interpret," Dr. Leslie noted.

That means it may take a pediatric cardiologist to interpret the results. And there are only about 1,500 pediatric cardiologists nationwide.

And then there's cost, Dr. Leslie said. "People point out that EKGs are inexpensive," she said, noting that the actual test runs about $10 to $25. But that's a lot when multiplied by millions of kids, and there's also the cost of interpreting those tests -- and then any follow-up that may be needed
.

Sudden Cardiac Arrest: Identifying Kids at Risk

An Article from Medscape.com

Victoria L. Vetter, MD, MPH

Posted: 04/09/2012

I am Dr. Victoria Vetter, a pediatric cardiologist at the Children's Hospital in Philadelphia. I'm speaking to you today about a policy statement just published by the American Academy of Pediatrics on pediatric sudden cardiac arrest. This paper identifies the conditions that are associated with sudden cardiac arrest in children. This can include structural functional abnormalities, such as hypertrophic cardiomyopathy and dilated cardiomyopathy; coronary anomalies; electrical conditions, such as long QT syndrome; and acquired conditions, such as commotio cordis, when there is a blow to the chest.

The paper outlines the warning signs and symptoms associated with sudden cardiac arrest. This would include fainting or syncope with exercise, chest pain with exercise, shortness of breath not associated with asthma in response to exercise, a family history of sudden cardiac arrest in someone younger than 50 years of age, or having a member who might be affected with one of the conditions that can cause sudden cardiac arrest.

Unfortunately, many individuals do not know their family history, but this is very important. Pediatric providers should make every attempt to investigate this in all children they are seeing, particularly those who are active, as sudden cardiac arrest is most likely to occur during activity. Of course, this includes most of our children. Providers also should be asking questions that specifically relate to the symptoms that were previously mentioned. Since this is a genetic condition, a molecular or genetic evaluation of affected family members or children who experience sudden cardiac arrest can often identify the cause of the arrest and identify additional individuals.

While we do not have a registry that counts the number of children who experience a sudden cardiac arrest, we are hopeful that the information in this policy statement will encourage people to consider that option, and thus identify the children who are experiencing these conditions. Further, if a school has an automated external defibrillator (AED) and an emergency plan to activate when such an event occurs, the child is much more likely to survive. Currently, the survival rate is 10%. It can be as high as 64% in schools where an emergency response plan is in effect.

Also, we would hope that individuals involved in schools would use this as an opportunity to develop curricula that include cardiopulmonary resuscitation and AED use. Every child who graduates from high school could then become a community bystander who would be available to help resuscitate an individual should they experience a sudden cardiac arrest.

The ways in which children can be identified with this condition include the warning signs and symptoms mentioned above. Unfortunately, symptoms are present in less than 50% of individuals. Thus, there is much discussion in the country at this time about other ways in which we might identify these individuals, including a debate about whether an electrocardiogram, which can identify up to 70%-95% of these conditions, should be used and whether genetic testing should be used in a more proactive fashion.

The paper concludes with a number of recommendations about the ways in which pediatricians may effectively work toward decreasing the tragedy of sudden cardiac arrest in our children.

© 2012 Children's Hospital of Philadelphia and Medscape