Background: Young athletes are at an increased risk of sudden cardiac death compared to others. Cardiac screening has been proposed to prevent deaths. We wished to review the evidence for cardiac screening of young athletes.
Method: We have conducted a literature search in PubMed on sudden cardiac death in young athletes, using a combination of search terms related to screening, incidence, cost efficiency and recommendations, supplemented by secondary references and articles from our own archive.
Results: Published studies utilise a variety of definitions of athlete and sudden death, and some studies also include cardiac arrest with subsequent successful resuscitation. Retrospective studies, often based on media searches, remain the most common form. The cause of death is not invariably determined by an autopsy. Recommendations in favour of screening are based on studies of limited quality and on the personal, often regional, experiences of experts.
Interpretation: The differences in study methods result in uncertain incidence figures. The estimates of cost efficiency are therefore questionable. To improve the quality of knowledge, standardised methods need to be devised, ideally also including a register of cardiac arrest in children and young people. To date, we have insufficient knowledge to recommend mandatory cardiac screening with ECG in Norway. Should this be introduced, it should be differentiated according to gender, type of sport and competition level. Cost efficiency could probably be improved with the aid of standardised questionnaires and a standardised interpretation of ECG among athletes.