is it better to find something or nothing

I have been helping with cardiac screenings for the past two years and as a company we have screened for eight. Last year it was rare to screen over twenty students and have all of them come back as low risk in medical terms or healthy in lay terms. We can't say words like "strong hearts", "good hearts", "happy and healthy", or "no problems". We have to use terms like low risk and high risk. The strongest thing that we can say is that someone has a normal ECG but that typically does not mean anything because our Cardiologists typically come back and correct what the machine says. We turn off the auto-interpretation because it is inaccurate and misleading to people we screen.

Since the first of 2012, we have modified what we look for and have refined our categorization of low risk and high risk as well as a follow up request because the ECG does not fit into either profile. A result of this modification has resulted in a larger number of low risk categorizations and a lower number of follow up requests. 

This change has prompted the question; what is better .... coming back with one high risk student from a group or coming back all low risk? We get press and attention when we find someone who no one knew had problems. Everyone wants to talk about a high risk student. Trainers and coaches want to know more information and talk to each other and us about the interpretation. Talk is good. Talk is healthy. It increases the discussion about what to look for. It increases awareness about the risks. It makes the coaches and trainers review their CPR and AED training programs. It brings the risk to their school and make it real for them without having to deal with a tragedy. This excitement crosses over to the parents and booster clubs start talking about making screening mandatory. It makes schools they compete against call us and ask if we can talk about screening at their schools. In my opinion, talk is good because it helps prevent a tragedy and prepares everyone to look for and act if and when something happens.

On the flip side, if we screen fifty seven students, like we did at Clifton High School in north Texas, or thirty five athletes, like we did at New Braunfels, and all come back as low risk there is little talk. In my opinion this is a stronger statement for a community that everyone we screened was healthy. Unfortunately, newspapers don't want to talk about how healthy and good their athletes are. Parents assume that their students will come back low risk so it does not surprise them. In 2011we screened 8,700 students across the state and 8,400 came back as low risk. This is 96.56% which in my opinion is a good thing. We saw 21, or about 0.24%,  categorized as high risk with one going through corrective surgery, two getting implants, three getting recategorized as low risk, and the rest being monitored for early stages of what could potentially become problems as they mature. Of the 278 that were asked to have follow up exams, one was categorized as high risk, twenty are being monitored for early stages of potential problems, and the rest are being asked to get screened again in two years even if they are still in middle school or high school. 

For the first half of this year we have screened 3,100 students, coaches, and teachers. We are seeing a higher percentage categorized as high risk (0.9%) but two thirds of these are coaches. One knew that he had heart problems and the other checked into the hospital after the screening and had surgery that weekend. We are seeing 96.39% cleared as low risk which is tracking with previous years. 

We are expecting to screen about 12,000 more students before the end of the year. This means that 60 students will be classified as high risk and 11,568 will be classified as low risk. What keeps me coming to work each day and shouting from the blogosphere that cardiac screening is a good thing is that each student that we categorize as high risk is a potential life saved. This means that the paper won't be reporting a student collapsed at practice, an ambulance was required at a stadium, an AED was able to shock someone back to life, or a school is mourning the loss of a student. On the flip side it also means that about 14,500 student can push themselves a little harder, dream of getting a college scholarship based on their athletic abilities, and help raise the level of competition in their district. I know that I push myself a little harder when I know that I have laid the proper foundation to take it to the next level. I can't swim a sub minute fifty meters until I break thirty seconds in a twenty five. I can't maintain a seven minute pace for a 10K until I can run a seven minute mile. Having an ECG listing me as low risk is just as important to me as heading to the pool for a morning training swim or an afternoon track workout. 

I will let you answer which is more impressive, finding the one student that potentially could collapse on the field or finding that all of you students are healthy and can take competition to the next level.