Thursday, April 26, 2012

Study Supports ECG Screening During Pre-Participation Exam to Identify Athletes at Risk of Sudden Cardiac Death

Released: 4/25/2012 3:30 PM EDT

Source: American Medical Society for Sports Medicine

Newswise — ATLANTA, Ga. – University of Washington researcher Jessie Fudge, MD received the Dr. Harry L. Galanty Young Investigator’s Award for excellence in sports medicine research at the 21st American Medical Society for Sports Medicine Annual Meeting in Atlanta, Ga. on April 24, 2012.

Dr. Fudge’s study “Cardiovascular Screening in Young Athletes : A Prospective Study Comparing the PPE Monograph 4th Edition and Electrocardiogram” looked at the challenging issue of identifying young athletes with undiscovered cardiovascular issues. It concluded that a standardized history and physical yields a high false-positive rate in a young active population and ECG screening is feasible and provides superior sensitivity and specificity.

“ECG screening, when interpreted with modern criteria for youth athletes, provides better sensitivity and specificity compared to current screening guidelines,” said Dr. Fudge. “The addition of ECG screening to the pre-participation exam may better identify athletes at risk for sudden cardiac death.”

A total of 1,339 subjects were screened. Echocardiograms were completed in 586 (44%) for concerning medical history (24%), family history (12%), physical exam (8%), or ECG (5%). Six (0.45%) were identified with a disorder known to cause sudden cardiac death (SCD). The sensitivity and specificity to detect disorders at risk of SCD were respectively 33% and 69% for history alone, 16% and 91% for physical exam, and 100% and 95% for ECG. Fifty percent of disorders known to cause sudden cardiac death were detected by ECG alone.

Co-authors of the research are Jonathan Drezner, MD; Kimberly Harmon, MD; David Owens, MD; Jordan Prutkin, MD, MHS; Irfan Asif, MD; Alison Haruta, Hank Pelto, MD; Ashwin Rao, MD; and Jack Salerno, MD all from the University of Washington

The conference featured lectures and research addressing the most challenging topics in sports medicine today including prevention of sudden death, cardiovascular issues in athletes, concussion, biologic therapies, and other controversies facing the field of sports medicine.

More than 1,200 sports medicine physicians from across the United States and 12 countries throughout the world attended the meeting.

The Galanty Young Investigator’s Award is presented at the AMSSM Annual Meeting for the most outstanding research presentation by a member who is a sports medicine fellow or who has rec ently completed fellowship training. The award was established in 2003 to honor Harry Galanty, MD, a charter member of the AMSSM, who passed away in 1999 at the age of 36. Dr. Galanty’s contributions to sports medicine combined clinical service, and a commitment to teaching and research.

Dr. Fudge is completing a fellowship in primary care sports medicine at the University of Washington. She completed a family medicine residency at UW.

The AMSSM is a multi-disciplinary organization of sports medicine physicians whose members are dedicated to education, research, advocacy, and the care of athletes of all ages. Founded in 1991, the AMSSM is now comprised of more than 2,000 sports me dicine physicians whose goal is to provide a link between the rapidly expanding core of knowledge related to sports medicine and its application to patients in a clinical setting.

Sunday, April 22, 2012

A race against time

One important skill — CPR — was as responsible as any for saving 11-year-old player.

Pete Iorizzo, Commentary

Published 11:11 p.m., Saturday, April 21, 2012

View from the pitcher's mound at Cook Park little league "majors" field in Colonie April 18, 2012. (John Carl D'Annibale / Times Union)

View from the pitcher's mound at Cook Park little league "majors"...

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Brian Manion, the co-president of South Colonie Youth Baseball, put $2,000 on his personal credit card Tuesday to buy his league a defibrillator.
"I'm sure they'll figure out how to reimburse me later," he said. "I just thought we needed to do this now."
Goldstock's, the sporting goods store in Scotia, sold out its entire stock of "heart guard" shirts, or padded undershirts marketed to protect children from blows to the chest.
Ditto for Play it Again Sports in Latham.
"Tons!" a sales associate said when asked how many heart guard shirts had been sold since Monday evening, when an 11-year-old Colonie Little League player nearly died at home plate after being hit in the chest with a pitch.
The story had a happy ending. Many don't. In youth leagues areawide, the near tragedy at Cook Park has jolted parents and coaches, sending them scrambling to ensure we don't test the odds again.
That's a good thing — but only so long as we're not misdirecting our energy toward unproven solutions or, worse, begetting fear and hysteria without cause.
What we really need to do is take a deep breath.
Because there is a very easy way to dramatically improve the safety of our playing fields, without spending a dime.
First, a little perspective: Most of us never had heard of commotio cordis before Monday, and that's because it happens only a handful of times each year, affecting a minuscule percentage of the millions who play youth sports.
Of course, that doesn't diminish the consequences for victims' families. Somewhere between 65 and 90 percent of commotio cordis cases end in tragedy. A 12-year-old lacrosse player from Rochester died just this past February.
Commotio cordis happens when a spherical object strikes a specific part of the heart at a precise fraction of a second between beats. The result is cardiac arrest.
But even if we understand what can turn a Little League fastball deadly, we're much less certain about what can make it safe.
Using swine that were placed under anesthesia and then fitted with heart guard shirts, the National Operating Committee on Standards for Athletic Equipment has tested most of the products now flying off the shelves of local sporting good stores.
The results: There's no proof they're effective.
"As a general rule, there's no scientific evidence that any of those products provide less protection or more protection," said Mike Oliver, the NOCSAE's executive director.
More worrisome, the research showed some of the shirts may actually increase the chances of commotio cordis.
How? For reasons that are unclear, balls traveling faster than 40 miles per hour are less likely to cause commotio cordis than those travelling a little slower.
The padding of the heart guard can take a 70-mile-per-hour fastball and soften the blow enough to create the impact of a 35 mph pitch. As counterintuitive as it sounds, the slower pitch may be more dangerous.
"That was a real surprise to us," Oliver said.
There's another problem: Equipping our kids with gear that's of dubious effectiveness could provide false peace of mind.
Just ask Karen Acompora. Her son Louis died in 2000, at age 14, while playing goalie in a Long Island high school lacrosse game.
"I hear parents say, 'Oh, it's fine, my kid is wearing a chest protector," Acompora said.
"Well," she said, "so was mine."
Soon after their son's death, Karen and her husband, John, became champions of legislation that makes it mandatory for every New York public school to have a defibrillator.
That's important, because a defibrillator offers the best chance of restarting the heart of someone who has suffered commotio cordis.
But Louis's Law, as it's known, doesn't cover recreational leagues, and at a cost of $1,200 to $2,000, defibrillators may fall beyond some leagues' means.
Those leagues still can take a major step toward making all their athletes safer, at virtually no cost.
How?
They can make every single one of their coaches learn CPR.
The lesson takes 15 to 20 minutes, and it can be done simply by watching instructional videos on the American Heart Association's YouTube site.
The Colonie Little League player is alive today because of the terrific teamwork executed by the coaches, first responders and emergency crews.
But if Frank Prevratil, the league president, hadn't begun chest compressions right away, and if Colonie police officer Brian Curran hadn't continued CPR when he arrived on scene, the EMS crew equipped with a defibrillator might not have saved the boy's life.
"In most communities, the first responders all carry some form of a defibrillator," said Bob Elling, a Colonie paramedic who serves on the board of the American Heart Association.
"But in order for the defibrillator to be successful, we really need to prime the pump. We need to start CPR immediately."
Elling has been a paramedic for 35 years.
"I've never once — not once — seen a case where someone survived and there wasn't someone who started CPR before we got there," he said.
The American Heart Association is pushing a law that would make it mandatory for all high school students to learn CPR before graduating.
Even if the last thing schools need is another mandate, surely asking every student to spend one class period learning the proper way to perform chest compressions wouldn't be too burdensome.
"You don't need anything special," Elling said. "There's no special equipment. Anybody could teach the class. You go to a website, watch a video demonstration, borrow a mannequin from the local rescue squad and have each student try the compressions.
"That's it. One class period."
We never can create enough rules or pass enough laws or develop enough safety equipment to remove all the danger from sports.
But we all can — and should — invest the 20 minutes it takes to be prepared for the worst. It will save lives. An 11-year-old boy is proof.
piorizzo@timesunion.com • 518-454-5425 • @peteiorizzo

Wednesday, April 18, 2012

Young batter hit by pitch in Colonie suffers rare heart stoppage, but quick response makes the difference

Teamwork proves vital as Little Leaguer revived

Young batter hit by pitch in Colonie suffers rare heart stoppage, but quick response makes the difference

By Pete Iorizzo

Updated 09:43 p.m., Tuesday, April 17, 2012


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The heart of an 11-year-old Little League baseball player started beating again Monday evening moments after he was hit by a pitch and nearly died at home plate.
The boy was batting in a Colonie Little League game at Cook Park when he was struck by a pitch and crumpled to the dirt. The pitch had hit him in the chest and stopped his heart.
A coach and police officer performed CPR before a defibrillator brought the boy back to life. He was recovering Tuesday at Albany Medical Center, police and coaches said.
"This was about everyone working together as a team," said Frank Prevratil, the president of Colonie Little League.
Prevratil, who also was the coach of the other team, was the first to begin CPR.
"There was no panic from anyone, no hysteria," Prevratil said. "Everyone did exactly what they were supposed to do."
Police and Colonie Little League officials declined to release the boy's name.
The boy may have suffered a condition called commotio cordis, which occurs when there is a blow to the heart at precisely the right fraction of a second to disrupt the organ's electric rhythms.
About 65 percent of commotio cordis victims die, though it accounts for only three or four deaths nationally each year, said Peter Berry, deputy chief of the Colonie EMS department.
"In my 23 years in the department, this is the first call for of this specific type of incident that I can recall," Berry said.
The call came into Colonie EMS dispatchers at 6:37 p.m. Monday, seconds after the boy had been hit, Berry said.
The boy's coach, Mike Martin, bolted from the dugout and realized the boy was having trouble breathing, Prevratil said.
Martin declined comment, other than to say the boy was doing well Tuesday.
When Prevratil saw the boy's coach needed further assistance, he rushed from his own dugout. On his way to home plate, he heard someone from the stands shout, "Call 911!"
While Martin and Prevratil tended to the boy, he slipped out of consciousness. That's when Prevratil began CPR.
He performed chest compressions for only about 30 seconds before Colonie police officer Brian Curran arrived on the scene, at 6:42 p.m., Colonie Police Lt. Robert Winn said.
Colonie Police declined to make Curran available for comment.
Curran took over CPR, but it was only two minutes before the EMT team reached the boy with a defibrillator.
His heart restarted while he still was lying in the batter's box, Prevratil said, and he was taken away by ambulance.
By that time, all the other players had been moved to another field, where they couldn't see what was happening at home plate.
"It was amazing to see everyone working so calmly," Prevratil said. "Everyone did what they were trained to do."
The umbrella Little League organization mandates that at least one coach of every team participate in a two-hour safety course, which covers everything from first aid to life-threatening incidents.
"I'm very proud of that training and the way it worked," Prevratil said.
In 2000, commotio cordis was responsible for the death of a 14-year-old lacrosse player from Long Island named Louis Acompora.
His death led to what is now called, "Louis's Law," which mandates all New York State public schools have defibrillators available at sporting events. But the law does not govern recreational leagues.
piorizzo@timesunion.com * 518-454-5425 * @PeteIorizzo