Sudden death of young athletes is a community issue

Friday night football resumes at high school football stadiums across the country tonight and hopefully most players will escape with minor bumps and bruises. But are we doing enough to protect our athletes from much worse?

The deaths this season of two teen football players in two days in one small area of New Jersey was considered a “statistical impossibility.” Weeks later, a third teenage player died in the very same county. These events defy all logic.

They also raise serious questions regarding medical screening of school-age athletes. At the center of the issue are deaths like that of Sean Fisher, a 13-year-old New Jersey boy who died because of undetected heart disease.

Undetected heart disease is often a congenital problem that involves many generations of a family. Family medical history plays a pivotal role detecting young athletes at risk of heart failure.

In my own family, the sudden death of an older family member sounded the warning for his young nephews.

In late 2005, my cousin Joseph died suddenly and prematurely at the age of 36 from a ruptured aorta. His sister, Melissa Soesman, a mother of three pre-teen boys, had her sons tested for underlying heart disease. They were given echocardiograms.

Their pediatric cardiologist found that each of the boys had enlarged aortas, over the 90th percentile. Each boy was to be monitored every year. After one year, the older boys ranked in the 70th percentile and were cleared for sports participation. The youngest boy has not been cleared.

Melissa now sounds like a doctor herself. She explains how an enlarged aorta is a package condition that can involve valves and other functions of the heart. Having passed through tragedy and crises, she offers this advice: “The parent has to be vigilant and get the required screenings done. But the key is you have to trust your cardiologist.”

Her children’s cardiologist is Dr. Robert Tozzi with Hackensack University Medical Center in New Jersey. He has very strong beliefs regarding the efficacy of testing for underlying heart problems in all children. He feels the entire community — not just the medical community — must be involved in policy making in this matter.

He notes that in Japan, since 1973, all children get an electrocardiogram in first, seventh and tenth grades. He cites a study done in Italy where all sports participants ages 12 to 35 have been given electrocardiograms since 1982. This has resulted in an 89 percent decline in sudden deaths of athletes — a fantastic result.

Dr. Tozzi looks at the problem in a broad context. He cautions that both frequency and intensity of athletic activity can impact outcomes. Athletes need to be in condition even during the off-season.

We need much more detailed pre-screening family history forms. This cannot be overstressed given the congenital nature of most undetected heart disease. The American College of Sports Medicine has developed one such form. A new, detailed form must be given to all school athletes and to those in community recreation leagues.

We must also reconsider administration of echocardiograms to young athletes. For example, Pennsbury High School in suburban Philadelphia administers one to every soccer player.

Many professional medical groups feel this is unnecessary. They cite low numbers of cases and high costs of administration. The cost argument can be countered by economies of scale — like a bulk rate — and insurance company negotiated rates, which are typically lower.

Sudden deaths of young athletes are a community issue and boards of education should see them as such. Serious discussion must follow. All standards and practices for screening athletes need re-evaluation.

• Silvio Laccetti is a social science professor at the Stevens Institute of Technology in Hoboken, N.J.