This week, the athletic department will decide whether to expand the Dartmouth’s cardiac screening program, according to Kristine Karlson, the director of Dartmouth-Hitchcock Medical Center’s sports concussion program. The screening program, piloted last fall, checked incoming varsity athletes for heart defects that increase the risk of sudden cardiac death.
Before last fall, athletes were only required to produce a physical workup from their home doctor before being cleared to compete in a varsity event. Under the piloted program, all incoming varsity athletes were administered electrocardiograms, or EKGs, a test in which electrodes attached around the body monitor the heart’s electrical activity.
Any abnormal readings are followed up by additional diagnostic testing at DHMC. Of the 250 incoming athletes screened with EKGs, according to Karlson, two were sent on for additional testing and eventually cleared for varsity competition. Nevertheless, it is necessary that Dartmouth expands the program.
Our understanding of sudden cardiac deaths has come a long way since college basketball star Hank Gathers’s death in 1990 shook the sports world and generated national interest in the reasons for young athletes’ sudden deaths. At 23 years old, Gathers collapsed in a nationally televised game and was declared dead on arrival. His death was caused by a congenital heart defect called hypertrophic cardiomyopathy, or HCM, the greatest culprit in sudden cardiac deaths in young athletes. EKG screenings indicate an abnormality in 90 percent of HCM cases.
While sudden cardiac death in young athletes is relatively rare, new studies have concluded that sudden cardiac deaths are more prevalent than previously thought. A 2011 study estimated one death in 43,770 NCAA athletes per year, debunking earlier estimates of around one in 300,000, which relied mostly on news reports. Until recently, widespread EKG testing was presumed prohibitively expensive and inefficient. However, a 2010 study by Stanford School of Medicine researchers estimated that at the cost of $88 per person, EKGs would add over two life years per 1,000 student athletes.
Though larger institutions have had similar screening programs for a few years now, smaller institutions have a harder time funding and statistically justifying these programs’ costs. EKG screening for all varsity Dartmouth athletes may be initially more expensive than the Stanford study estimates, but it would still be cost-efficient. The incremental cost of screening will still pale in comparison to ancillary athletic expenses such as clothing, gear and travel. Furthermore, the College has an ethical obligation to its student athletes to reduce unnecessary medical risks if doing so is within its capability.
Extending EKG screening to all varsity athletes is an improvement, not a solution, in the fight against sudden cardiac deaths. More medical organizations are endorsing universal EKG testing as the new norm for young athletes. If this trend continues and the cost-benefit calculus holds, the College risks becoming liable for any sudden cardiac death in which it did not administer an EKG to the athlete.
Abnormal EKGs require further testing to rule out false positives, usually from a benign condition called “athlete’s heart.” If an athlete does have a disqualifying heart defect, what is the next step? Precautions like beta-blockers hinder athletic performance and implanted defibrillators offer no guarantee in high-stress situations. Colleges reserve the right to bar athletes from varsity competition, but what about from club or intramural sports? Is the College liable for anyone in a green jersey?
If the EKG program is expanded, as it should be, then the College will face a number of logistical hurdles. To practically screen 250 athletes, the College needed half a dozen EKGs, Karlson said, but it had one. The College had to hire technicians and physicians from DHMC to administer and read the tests, forcing all the screening to be done in a single weekend at Dick’s House, a space that will not accommodate 750 unscreened athletes next fall. Moreover, if the College moves in the right direction, student initiatives, volunteerism and funding campaigns will be vital to the program’s success. But these are small problems when compared to reducing sudden deaths among our varsity athletes.
Xander Greer’16 is a guest columnist.
