Paediatric and adolescent athletes in Switzerland: age-adapted proposals for pre-participation cardiovascular evaluation

Abstract

High-level sports competition is popular among Swiss youth. Even though preparticipation evaluation for competitive athletes is widespread, screening strategies for diseases responsible for sudden death during sport are highly variable. Hence, we sought to develop age-specific preparticipation cardiovascular evaluation (PPCE) proposals for Swiss paediatric and adolescent athletes (under 18 years of age). We recommend that all athletes practising in a squad with a training load of at least 6 hours per week should undergo PPCE based on medical history and physical examination from the age of 12 years on. Prior to 12 years, individual judgement of athletic performance is required. We suggest the inclusion of a standard 12-lead electrocardiogram (ECG) evaluation for all post-pubertal athletes (or older than 15 years) with analysis in accordance with the International Criteria for ECG Interpretation in Athletes. Echocardiography should not be a first-line screening tool but rather serve for the investigation of abnormalities detected by the above strategies. We recommend regular follow-up examinations, even for those having normal history, physical examination and ECG findings. Athletes with an abnormal history (including family history), physical examination and/or ECG should be further investigated and pathological findings discussed with a paediatric cardiologist. Importantly, the recommendations provided in this document are not intended for use among patients with congenital heart disease who require individualised care according to current guidelines.

Prevention of sport-related health issues

“…sdílených rozhodnutí (shared decision), kdy si sportovec a jeho zákonný zástupce může zvolit u nekritického kardiologického nálezu akceptování určitého rizika při pokračování své sportovní kariéry. (23) Žádný screening neodhalí riziko NSS ve sto procentech případů. Proto se v poslední době klade důraz na reaktivní strategii v prevenci NSS.…”

Sport activities for children and adolescents: the Position of the European Academy of Paediatrics and the European Confederation of Primary Care Paediatricians 2023—Part 1. Pre-participation physical evaluation in young athletes

“…General age criteria for participation in sports Pediatric and adolescent athletes who are younger than 18 years of age may be defined as participating in competitive sports at a high level if they are practicing in a team setting for at least 6 h per week (31). Not all exercises have the same consequences for an individual's health status, whether positive or negative (40,41).…”

“…Age-specific pre-participation cardiovascular evaluation (PPCE) proposals for Swiss pediatric and adolescent athletes (under 18 years of age) were published in 2022 ( 31 ).…”

“…In Switzerland, it is recommended that all young athletes practicing with a team with a training load of at least 6 h per week undergo PPCE based on medical history and physical examination from the age of 12 years onward. Inclusion of a standard 12-lead ECG evaluation is also suggested for all post-pubertal athletes (or older than 15 years) with an analysis in accordance with the International Criteria for ECG Interpretation in Athletes ( 31 ).…”

Catastrophic Sports Injuries

“…Although electrocardiographic screening is employed by most professional leagues, there are no mandatory universal electrographic screening recommendations for nonprofessional U.S. athletes. Cardiac screening tests, with higher sensitivity rates and improved cost-effectiveness, at the nonprofessional levels are critical next steps for reducing sudden cardiac death 18,25 .…”