Pre-participation screening for the prevention of sudden cardiac death in athletes

Table 1 Italian and United States pre-participation screening strategy

Italian pre-participation screening		United States pre-participation screening
Advantage	Disadvantage	Advantage	Disadvantage
Rest ECG screening power (ionic-channel disorders, arrhythmias and cardiomyopathies)	Higher cost	Lower cost	Low diagnostic power in the detection of silent cardiovascular diseases
Post exercise ECG diagnosis (arrhytmias, stress-induced myocardial ischemia)	More complicated logistic	Easy logistic	Impossibility to detect post exercise ECG alterations
Spyrometry (pulmonary diseases)	More false positive	Less false positive	Only clinical diagnosis of pulmonary diseases
Urine analysis (diabete, proteinuria, kidney, liver and urogenital infectious diseases)	Possible psychological ramification of the screening	Easy feasibility	Athletes can compete without permission (PPS is not mandatory)
In Italy athletes health is protected by law (PPS is mandatory)			Many cardiovascular disorders cannot be detected by physical examination

ECG: Electrocardiogram; PPS: Pre-participation.

Table 2 Cost-efficacy trials

Studies	Considerations
Cost effectiveness analysis of screening of high school athletes for risk of sudden cardiac death[48]	A more favourable cost-effectiveness ratio of ECG when compared to medical history collection and physical examination or 2D echocardiograph
Cost-effectiveness of preparticipation screening for prevention of sudden cardiac death in young athletes[49]	Screening young athletes with 12-lead ECG plus cardiovascular-focused history and physical examination may be cost-effective
Usefulness and cost effectiveness of cardiovascular screening of young adolescents[50]	The cost of this screening system was lower when compared to the United States model
An electrocardiogram should not be included in routine prepartecipation screening of young athletes[52]	Implementing PPS with ECG could be too much expansive in the United States, in consideration of the enormous number of competitive high school and college athletes
Preventing sudden death of athletes with electrocardiographic screening: What is the absolute benefit and how much will it cost?[53]	The Italian strategy of ECG screening in the United States would result in enormous costs per life saved

ECG: Electrocardiogram; PPS: Pre-participation.