A best practice model of a school preventive health program to identify conditions associated with sudden cardiac arrest in the young

Background: Over 1,000 school-aged children die in the United States (US) annually of sudden cardiac arrest (SCA), incidence of 0.6–8/100,000, representing 5% of childhood deaths. The electrocardiogram (ECG) identifies previously undiagnosed cardiac conditions responsible for SCA in at least two-thirds of cases. In Europe, screening includes an ECG, but in the US, only history and physical exam is used with no consensus as to the best screening model. Purpose: To develop a Best Practice recommendation of a feasible ECG-based screening model that could be applied to a school-aged population in the US. Significance: An effective method to identify those at risk is a first step toward the prevention of these untimely deaths. Methodology: We evaluated five models: three IRB-approved ECG screening models, one office-based and two school-based, a community-based mass screening, and two Italian Screening Center models. All included a health questionnaire and ECG. Some included echocardiogram and exam. Findings: One percent of 2347 healthy school children had previously undiagnosed potentially serious cardiac conditions that required intervention, follow-up medical care, and lifestyle modifications. Recommendations: The Best Practice model that we recommend utilizes schools, or existing offices or clinics. To identify children prior to a time of highest risk, we suggest targeted screening of all school-aged children, not just athletes, in the age group over 10 years. Our pilot screening and school studies have shown that it is possible to screen a population of school-aged children in the US using an ECG in addition to a history and physical exam.