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Survival of the Fittest: Protecting Lives of Student Athletes

A new bill hopes to help detect heart abnormalities in children and teenagers before they participate in potentially life-threatening sports.

B.J. Giannone, 18, climbed out of a pool and collapsed of a heart attack on Jan. 31, 2011, moments after completing a relay race for his St. Peter's Prep swim team in Jersey City. The sudden death of student athletes, cut down in the heat of competition, claims more than 100 lives each year in the United States, and legislation will be introduced in Trenton this week that aims to improve the screening of children and teenagers to detect heart abnormalities before they participate in sports that might be life threatening.

Sen. Fred. H. Madden (D-Gloucester) said he will introduce on Thursday the first of several bills to implement recommendations by the New Jersey Student Athlete Cardiac Sceening Task Force, which was created in 2010 by legislation that Madden sponsored. The task force report, made public in April, does not recommend that all student athletes have an electrocardiogram as part of the routine physical that is required before participating in school sports. Rather, the report advocates doing a more thorough job of obtaining a family medical history, to flag any genetic heart defects, and providing specialized training to the physicians and advanced practice nurses who conduct sports physicals, so they are vigilant for possible cardiac problems.

Student athletes whose family history and medical exam place them at greater risk would then become candidates for an EKG. The report also recommends that health insurance plans be required to cover an annual sports physical that is focused on cardiac and musculoskeletal health. And the report recommends that an automatic external defibrillators (AEDs) be close at hand during practice and competition, and that coaches, teachers, athletes, and others involved in schools sports be trained in their use.

The task force was chaired by Dr. Stephen Rice, president of the American Academy of Pediatrics, New Jersey chapter, and a specialist in pediatric sports medicine. Rice said the task force decided it was not feasible at the present time to recommend that all student athletes have an EKG, both because of the cost and because the test would likely generate an excessive number of false positives.

"However," he said, "advances are being developed that are sharpening up the criteria for normal and abnormal [readings] on the EKG. It may become less expensive and produce fewer false positives, and we may be revisiting the issue" of whether to make the EKG a standard feature of the school sports physical.

Madden said his legislation will require additional training in cardiac assessment for healthcare professionals who screen student athletes. "We can improve the screening, and do a better job of identifying at-risk athletes, and then do EKGs" on those who are at risk, Madden said. "The task force recommendations will make sure have a stronger system in New Jersey for the way we screen our student athletes. Coupling that with the insurance companies paying for the cost of additional screening, is critical."

EKGs for student athletes, before they participate in sports, have been conducted since 2007 by the Matthew J. Morahan, III Health Assessment Center for Athletes at the Barnabas Health ambulatory care center in Livingston. Dr. Donald Putnam, medical director, said the center has screened 1,500 student athletes so far, and has identified a handful of heart abnormalities that he said were not life threatening. He estimates that between one in 100 thousand and one in 200 thousand people have the kind of heart defect that would disqualify them from sports.

"We're talking about trying to find a needle in a haystack." Nevertheless, Putnam advocates performing a baseline EKG on all children as they move from primary to middle school. "If we can save one kid in the state of New Jersey, I feel that we have done the right thing. We should not have young kids dying on athletic fields in this day and age with what we have available to us."

Rice said, "If we get a good family history and do a good physical, that will help us identify the people who really do need an EKG." Parents need to understand the importance of providing a thorough family history when filling out forms for sports participation, Rice said. "That is how a lot of tragedy that could be prevented."

Rice added that hypertrophic cardiomyopathy, a genetic disorder that produces abnormal thickening of the heart muscle, is the number one cause of sudden death in athletes. There have been cases where a teenager has died suddenly while playing sports and "when you actually sit down with the family afterwards you find out that a cousin or an uncle also died suddenly. Getting a complete family history is very, very important."

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