Incidence of sudden cardiac death in Minnesota high school athletes 1993-2012 screened with a standardized pre-participation evaluation

J Am Coll Cardiol. 2013 Oct 1;62(14):1298-1301. doi: 10.1016/j.jacc.2013.05.080. Epub 2013 Jul 10.


Objectives: This study sought to determine the incidence of sudden cardiac death (SCD) during Minnesota State High School League (MSHSL) games and practices for high school (HS) athletes (12 to 19 years of age, with most age 15 to 18 years of age) using a uniform statewide pre-participation health screening examination (PPE) form every 3 years on a defined population across 19 academic years.

Background: Adding electrocardiographic screening is being considered by some to reduce cardiac death rates in athletes, but the death rates in defined groups screened by the current U.S. PPE recommendations are unknown.

Methods: MSHSL participation records were surveyed to determine the number of unduplicated athletes for 1993/1994 through 2011/2012 academic years, and catastrophic insurance records were used to find cardiac deaths.

Results: There were 4 SCDs (2 cross country, 1 basketball, 1 wrestling), all male, during practice or games in 1,666,509 unduplicated athletes participating in ≥ 1 sports. The incidence of SCD in athletes screened every 3 years with a history and physical during MSHSL activities is 0.24 per 100,000 athlete-years over 19 years and 0.11 per 100,000 athlete-years over the past decade.

Conclusions: The incidence of SCD in athletes screened every 3 years with standard PPE during MSHSL activities is 0.24 per 100,000 athlete-years in 19 academic years. This incidence is much lower than that observed in studies of Division 1 National Collegiate Athletic Association and Italian athletes (ages 18 to 25 and mean age 24 years, respectively). Our data do not warrant screening HS athletes with electrocardiography to prevent SCD episodes. The decision to screen athletes with electrocardiography should consider age, training intensity, and genetic predisposition.

Keywords: AHA; American Heart Association; ECG; HS; MSHSL; Minnesota State High School League; NCAA; National Collegiate Athletic Association; PPE; SCD; athletes; electrocardiogram; electrocardiographic screening; exercise; high school; pre-participation health screening examination; sports; students; sudden cardiac death.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Athletes*
  • Cause of Death / trends
  • Death, Sudden, Cardiac / epidemiology*
  • Death, Sudden, Cardiac / etiology
  • Electrocardiography
  • Female
  • Humans
  • Incidence
  • Male
  • Mass Screening / methods*
  • Minnesota / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Schools*
  • Students / statistics & numerical data*