Why Are 12-Leads Not Required For School Physicals

[Tigger]

You know there was a time when AED's in malls, office buildings and airports was deemed very impractical with much resistance against it? Some were saying defibrillation was an advanced skill, was dangerous for minimally trained people, etc, etc. Guess who was wrong??

Never mind the fact that AEDs have come a long way in terms of simplicity of use in the last 15 years, I see this comparison as rather apples to oranges. Those AEDs have a very low reoccurring cause and have the potential to save many more thousands of people per year. I doubt it's been studied, but I'd put money on school AEDs being used more on adults than children. I'd much rather see an AED at every youth sporting event before mandatory 12 leads, no screening program is going to prevent any comotio cordis type incidents that a rapidly used AED has the ability to remedy.

 

[18G]

Never mind the fact that AEDs have come a long way in terms of simplicity of use in the last 15 years, I see this comparison as rather apples to oranges. Those AEDs have a very low reoccurring cause and have the potential to save many more thousands of people per year. I doubt it's been studied, but I'd put money on school AEDs being used more on adults than children. I'd much rather see an AED at every youth sporting event before mandatory 12 leads, no screening program is going to prevent any comotio cordis type incidents that a rapidly used AED has the ability to remedy.

It's the mentality surrounding that was the point.

Everyone speaks of the "high cost". It's being shown that the cost isn't that high at all. Like JWK pointed out, an echo performed and read by a cardiologist for only $75.

I think mandatory 12-leads should still be required. But I also think that as long as parents/students are given information by the physician directly and in the form of a hand-out at the time of the physical and a discounted rate is offered for a 12-lead and echo, that would be a great option too.

I think by law parents should have to be informed of the potential risk and benefit of additional screening level with ECG and Echo.

 

[Veneficus]

It's the mentality surrounding that was the point.

Everyone speaks of the "high cost". It's being shown that the cost isn't that high at all. Like JWK pointed out, an echo performed and read by a cardiologist for only $75.

I think mandatory 12-leads should still be required. But I also think that as long as parents/students are given information by the physician directly and in the form of a hand-out at the time of the physical and a discounted rate is offered for a 12-lead and echo, that would be a great option too.

I think by law parents should have to be informed of the potential risk and benefit of additional screening level with ECG and Echo.

How many kids play school sports across the country?

At $75 each, (which I think is area dependant anyway) every year, in just a few short years, that is going to be a lot of money.

If there are 1 million high school athletes in the US per year, that is 75 million a year.

Let's say you save 10 lives (probably over estimated by double) You are still spending 7.5 million per year for that.

I can think of dozens of ways to save a lot more lives than 10 for $7.5 million

 

[18G]

How many kids play school sports across the country?

At $75 each, (which I think is area dependant anyway) every year, in just a few short years, that is going to be a lot of money.

If there are 1 million high school athletes in the US per year, that is 75 million a year.

Let's say you save 10 lives (probably over estimated by double) You are still spending 7.5 million per year for that.

I can think of dozens of ways to save a lot more lives than 10 for $7.5 million

That's a nice spin on numbers.

If parent's want to spend money they worked for to screen their child then your numbers become irrelevant since it's not millions of dollars. It then becomes only $75.

What's the difference if someone spends $75 on an ECG or Echo or spends it at Wal-Mart?? A parent is free to spend their money on whatever they choose and if they feel it's a worthwhile investment into their child's well being then what's it matter to anyone else? At the end of the day it's not you that has to see the $75 come out of your bank account or possibly see the result of not having the screening done. $75 isn't much for having peace of mind.

The only people this screening would be affecting are the ones paying for it out of pocket if this model is used.

 

[Veneficus]

That's a nice spin on numbers.

If parent's want to spend money they worked for to screen their child then your numbers become irrelevant since it's not millions of dollars. It then becomes only $75.

What's the difference if someone spends $75 on an ECG or Echo or spends it at Wal-Mart?? A parent is free to spend their money on whatever they choose and if they feel it's a worthwhile investment into their child's well being then what's it matter to anyone else? At the end of the day it's not you that has to see the $75 come out of your bank account or possibly see the result of not having the screening done. $75 isn't much for having peace of mind.

The only people this screening would be affecting are the ones paying for it out of pocket if this model is used.

but if it is mandated, then somebody has to pay. What about the people who cannot afford it, should they be prohibited from playing?

 

[Akulahawk]

That's a nice spin on numbers.

If parent's want to spend money they worked for to screen their child then your numbers become irrelevant since it's not millions of dollars. It then becomes only $75.

What's the difference if someone spends $75 on an ECG or Echo or spends it at Wal-Mart?? A parent is free to spend their money on whatever they choose and if they feel it's a worthwhile investment into their child's well being then what's it matter to anyone else? At the end of the day it's not you that has to see the $75 come out of your bank account or possibly see the result of not having the screening done. $75 isn't much for having peace of mind.

The only people this screening would be affecting are the ones paying for it out of pocket if this model is used.

but if it is mandated, then somebody has to pay. What about the people who cannot afford it, should they be prohibited from playing?

I agree greatly with Vene here. If 12-leads and/or echo tests become mandatory, that will automatically cut out a LOT of kids from playing simply from the family economics. Must the kids be tested once? Annually? Since it is mandatory by a public agency, will there be subsidized testing for those that cannot afford it? Who will do the means testing to determine that? While an ECG and/or echo could catch some problems early on, those things won't help those that can't pay, nor will it really help prevent problems later on. Why? You're not going to keep your heart rate down to a non-stressed level, even if you're not an athlete. Could it be that vigorous horizontal activity (say in a bed or back seat of a car) might just get your heart going? Could it be that you experience something really scary and your heart goes racing?

Then suppose that a problem is found that is correctable, say, surgically. Who pays for the procedure now that it has been found by a mandated program?

Personally, I think that doing these studies should be completely upon the request of the family of each athlete. It would be nice to have info by the team physician and/or ATC, but, I feel that money would be far better spent purchasing AED's and having them immediately available during practices and games than purchasing 12-lead machines.

Oh, and what about private sports leagues? Who regulates who plays there? Certainly schools can't... so those kids that can't get the studies done and are prevented from playing in a school-sanctioned sports program can just find a private group and play there. Imagine the lawsuit for being refused to play by a school because the kid can't get a screening done and then the kid suffers a cardiac event during that non-school regulated play and this could have been caught by this mandated but uncompensated screening?

Oh... Yeah, I can go on...

 

[18G]

I agree greatly with Vene here. If 12-leads and/or echo tests become mandatory, that will automatically cut out a LOT of kids from playing simply from the family economics. Must the kids be tested once? Annually? Since it is mandatory by a public agency, will there be subsidized testing for those that cannot afford it? Who will do the means testing to determine that? While an ECG and/or echo could catch some problems early on, those things won't help those that can't pay, nor will it really help prevent problems later on. Why? You're not going to keep your heart rate down to a non-stressed level, even if you're not an athlete. Could it be that vigorous horizontal activity (say in a bed or back seat of a car) might just get your heart going? Could it be that you experience something really scary and your heart goes racing?

Then suppose that a problem is found that is correctable, say, surgically. Who pays for the procedure now that it has been found by a mandated program?

Personally, I think that doing these studies should be completely upon the request of the family of each athlete. It would be nice to have info by the team physician and/or ATC, but, I feel that money would be far better spent purchasing AED's and having them immediately available during practices and games than purchasing 12-lead machines.

Oh, and what about private sports leagues? Who regulates who plays there? Certainly schools can't... so those kids that can't get the studies done and are prevented from playing in a school-sanctioned sports program can just find a private group and play there. Imagine the lawsuit for being refused to play by a school because the kid can't get a screening done and then the kid suffers a cardiac event during that non-school regulated play and this could have been caught by this mandated but uncompensated screening?

Oh... Yeah, I can go on...

Screenings take place for a reason. Is it fair some people are disqualified from going into the military because of seemingly stupid medical reasons? If a diabetic takes insulin, they cannot hold a DOT certificate and as such can not work. For me, that would mean I couldn't work as a Paramedic. Is that fair??

Yeah, guess what, your kid can't play sports but instead we're going to inform you of a problem you wouldn't have otherwise known about and give you options for dealing with it.

A parent could have the right to sign a waiver and allow their kid to play anyway. It should ultimately fall on parent and student for deciding. But they need armed with the information first.

 

[Tigger]

Screenings take place for a reason. Is it fair some people are disqualified from going into the military because of seemingly stupid medical reasons? If a diabetic takes insulin, they cannot hold a DOT certificate and as such can not work. For me, that would mean I couldn't work as a Paramedic. Is that fair??

Yeah, guess what, your kid can't play sports but instead we're going to inform you of a problem you wouldn't have otherwise known about and give you options for dealing with it.

A parent could have the right to sign a waiver and allow their kid to play anyway. It should ultimately fall on parent and student for deciding. But they need armed with the information first.

I don't think a waiver is going to be enough to protect a school district from getting sued if they screen a child and discover that they have a cardiac condition yet the parents allow to play. Peoria sign away their right to sue all the time, and then still sue anyway. Even if the school could easily found liable they still have to pay legal fees. Why would any school allow someone to compete in their program with a known heart condition?

 

[Smash]

Yeah, guess what, your kid can't play sports but instead we're going to inform you of a problem you wouldn't have otherwise known about and give you options for dealing with it.

Or we are going to "inform" you about a false positive, meaning your kid, who is absolutely healthy, doesn't get to play sport. Or worse, we are going to inform you of a false negative, so your kid dies anyway. Then you can come back and sue the doctor, the tech, the school, the state, whoever the hell you feel like taking to the cleaners.

After the first (inevitable) death, when a kid has had it's ECG and echo, both of which appear normal, do you then start demanding genetic screening or biopsy? It's insanity to require an inexact science to screen for something that really isn't (in the overall scheme of things) an issue.

Again, look at the harm the breast screening can do to see what the application of widespread screening programs can achieve.

If the kid has something like exercise related sycnope or chest pain, sure, go get an ECG. But to screen the millions of kids who play sport is just mental. One of the biggest emerging health issues the developed world has is childhood obesity. Why the hell would you throw up more impediments to kids being active by instituting a program that is going to cost a lot of money for little (if any) gain?

 

[18G]

Smash,
Instead of offering your own opinion, what is your view on the research findings obtained by leading cardiologists? They used a scientific method and yielded results that say offering a 12-lead as part of the exam is beneficial and cost effective and increase the chance of catching at-risk youth. And not just one study but several coming to the same conclusion.

It's also been studied and found that the typical physical exam and questionnaire alone is not very specific at all and by adding an ECG, it significantly increases the sensitivity of the exam.

 

[VFlutter]

Smash,
Instead of offering your own opinion, what is your view on the research findings obtained by leading cardiologists? They used a scientific method and yielded results that say offering a 12-lead as part of the exam is beneficial and cost effective and increase the chance of catching at-risk youth. And not just one study but several coming to the same conclusion.

It's also been studied and found that the typical physical exam and questionnaire alone is not very specific at all and by adding an ECG, it significantly increases the sensitivity of the exam.

Wouldn't his view on research still just be his opinion? I still do not think you will win the argument that it should be required or mandated. I think we will all agre that yes it's a great idea and every parent should be given the information and opportunity and then be allowed to make an informed decision.

 

[Smash]

Smash,
Instead of offering your own opinion, what is your view on the research findings obtained by leading cardiologists? They used a scientific method and yielded results that say offering a 12-lead as part of the exam is beneficial and cost effective and increase the chance of catching at-risk youth. And not just one study but several coming to the same conclusion.

It's also been studied and found that the typical physical exam and questionnaire alone is not very specific at all and by adding an ECG, it significantly increases the sensitivity of the exam.

I have yet to see these studies. I have trawled through every link posted so far in this thread. The vast majority of the support for ECG screening comes from such luminaries of the medical literature as NBC News' Today Health or the New York Times, or from organisations with a vested interest in such a program.
There's a press release from Stanford (without the actual study referred to) and the previously discussed "ECG screening is not clinically useful but makes us all get along better, and is therefore worth the cost" study.
There is the Italian study, and the reasons why this is probably not relevant to other areas has already been discussed. There are also a couple of negative studies.

So if you would like to post these studies you refer to, please do and I will give you my opinion on them.

 

[Akulahawk]

Screenings take place for a reason. Is it fair some people are disqualified from going into the military because of seemingly stupid medical reasons? If a diabetic takes insulin, they cannot hold a DOT certificate and as such can not work. For me, that would mean I couldn't work as a Paramedic. Is that fair??

Yeah, guess what, your kid can't play sports but instead we're going to inform you of a problem you wouldn't have otherwise known about and give you options for dealing with it.

A parent could have the right to sign a waiver and allow their kid to play anyway. It should ultimately fall on parent and student for deciding. But they need armed with the information first.

The screenings you describe all are quantifiable. You either meet the criteria or you do not. Those screenings use tools that are fairly definitive. In the Military, they use screenings for determining fitness as a combatant. Lets use color blindness: you can either see the full spectrum or you can not. Not being able to see the full color spectrum could lead you to put others in danger because you couldn't see something was amiss. How about hearing? They require binaural hearing. If you can't locate sounds well, you may not be able to determine where a threat sound came from and respond appropriately... thus leading to possibility of injury/death. These are quantifiable things.

Screening every athlete for cardiac problems by ECG and/or Echo will cost a LOT and hopefully someone doing the screening would be familiar with the anatomical and physiological changes that do occur in athletes. There will be false positives and false negatives. Those will be problematic... especially from a legal standpoint.

It's quite unlike being an insulin-dependent diabetic and not being able to get a commercial driver's license. You either need it or you do not. Needing it puts you at risk for accidental overdose of the insulin, which as we all know, is NOT a good thing for safety reasons. Now if the IDDM is able demonstrate good control of their blood sugar and is also therefore able to correctly dose their insulin, I personally have ZERO issues with them getting a commercial driver's license or any other license/certificate allowing them control of even a passenger carrying airliner.

If athletes were willing to be completely honest during their exams about symptoms that may point to cardiac issues, then I can see mandating and paying for ECG and Echo studies on a case-by-case referral system. I have seen just how deceptive that athletes will be just so they can play. Not just once, but many times. I'm sure Tigger has too...

 

[Tigger]

The screenings you describe all are quantifiable. You either meet the criteria or you do not. Those screenings use tools that are fairly definitive. In the Military, they use screenings for determining fitness as a combatant. Lets use color blindness: you can either see the full spectrum or you can not. Not being able to see the full color spectrum could lead you to put others in danger because you couldn't see something was amiss. How about hearing? They require binaural hearing. If you can't locate sounds well, you may not be able to determine where a threat sound came from and respond appropriately... thus leading to possibility of injury/death. These are quantifiable things.

Screening every athlete for cardiac problems by ECG and/or Echo will cost a LOT and hopefully someone doing the screening would be familiar with the anatomical and physiological changes that do occur in athletes. There will be false positives and false negatives. Those will be problematic... especially from a legal standpoint.

It's quite unlike being an insulin-dependent diabetic and not being able to get a commercial driver's license. You either need it or you do not. Needing it puts you at risk for accidental overdose of the insulin, which as we all know, is NOT a good thing for safety reasons. Now if the IDDM is able demonstrate good control of their blood sugar and is also therefore able to correctly dose their insulin, I personally have ZERO issues with them getting a commercial driver's license or any other license/certificate allowing them control of even a passenger carrying airliner.

If athletes were willing to be completely honest during their exams about symptoms that may point to cardiac issues, then I can see mandating and paying for ECG and Echo studies on a case-by-case referral system. I have seen just how deceptive that athletes will be just so they can play. Not just once, but many times. I'm sure Tigger has too...

Everything I wanted to say and more. And while we will never have a 100% compliance rate with athlete honesty on health questionnaires (I've stopped counting how many times I've misled on concussion tests) I do not think that is a reason to implement an ECG screening program. This is especially true considering that the majority of the athletes in question are under 18 and therefore subject to parent answering of health questionnaires. If risk factors exist I think these select kids should have mandatory screening, and this is already the case at most institutions.

 

[18G]

These programs are becoming more and more prevalent.

http://www.columbian.com/news/2013/feb/25/heart-screening-effort-gets-national-attention/


"The Young Champions program holds biannual mass screening events; the most recent event was Saturday. During those events, physicians and nurses volunteer their time to screen more than 300 kids. The screenings are free, although the program asks for a $25 donation to help pay for future efforts.

The program also offers heart screening appointments throughout the week. Physicians at the Heart and Vascular Center schedule the screenings for when they have breaks between adult appointments, said Matt Nipper, an exercise physiologist for the center.

Those screenings cost $50, but the foundation helps cover that cost for families who cannot afford the visit.

The Young Champions model is unique, Nipper said, because it partners a community hospital with a local nonprofit organization. Most groups that offer heart screenings partner with one physician or one medical office, not an entire health system, he said.

"We're on the cutting edge of providing these screenings, especially within a health system environment," Nipper said.

 

[Chewy20]

You seriously brought up a thread from over two years ago just to leave a "smiley face"?

I award you no points, and may god have mercy on your soul.