SWATA and Sudden Death

On July 19th I attended the Southwest Athletic Trainers Association annual conference. I was excited to attend because two of the talks were about sudden death and how to prepare/prevent it. This sounds like something that Cypress ECG would be interested in following and helping with.

The talk was moderated by Kenny Boyd of The University of Texas at Austin and keynote presenter was Katie Walsh of East Carolina University. Overall the talk was good but lacked emphasis where I feel it needed to be. The top eight causes of death listed are

1. Asthma
2. Concussions/Brain Injury
3. Spinal Injury
4. Diabetes
5. Heat Stroke
6. Sickle Cell reaction
7. Lightning
8. Sudden Cardiac Death

Given that Dr. Walsh is the US expert on lightning, the majority of the talk centered on detection, process and procedures, and the cost of monitoring. What was troubling was that Sudden Cardiac Death was not mentioned in the afternoon session and presented briefly in the morning session. 

Let's put things in perspective.

Asthma - about 8% of the population has asthma at all ages. Rates are higher for children below 18 with 9.5%. This means that one in ten kids statistically has asthma. Based on the CDC numbers about 90% of people diagnosed with asthma see a doctor for medication, 10% visit an emergency room on an annual basis, two percent are hospitalized, and less than one third of one percent die from the disease. The death rate for asthma is 0.15 per 1000 with the majority of those being in the 65 and older age group. For under 18 the rate is 0.09 per 1000 of those with the disease. This correlated to about one in 100,000 at risk for the under 18 age group.

Given that the equipment cost for Asthma is a Spirometer and medication that the student brings, schools can easily prepare for this but do need to perform baseline exams and record this information on the annual physicals. Many doctors will do this as part of the physical and if not athletic trainers or the school nurse can perform the screening for less than $200.

Concussion/Brain Injury/Spinal Injury - This is a topic that has had much discussion in the past two years and we don't need to go much more in depth here. The equipment for screening and testing of this is less than $1000 and is mandated by the state of Texas. 

Diabetes - About 10% of the population has diabetes. The number drops to less than 4% when you talk about under the age of 18. It is difficult to site death rates because diabetes causes other diseases like kidney failure, heart disease and stroke, and is the seventh leading cause of death in the US. Prevention and treatment is typically a glucose meter or something to measure blood sugar and does not exceed a few hundred dollars.

Heat stroke is another cause of death. Between 1999 and 2003 there were 3442 deaths, about 228 or 7% were under 15.  This puts the death rate at less than one per 100,000 in the general population and one per 1,000,000 in the under 18 age group. Treatment is simple if diagnosed early and properly. Most trainers know how to deal with this problem but it has been in the new lately as this has been a hot summer.

Sickle Cell is a genetic blood disorder that effects 50,000 US citizens annually. The disease is typically caught early and treated before the age of 3. Mortality rates in the US have dropped to less than one per 100,000 for this disease. The disease is significant in other countries and specific racial groups but a student in middle school or high school should know ahead of time if they have the disease and alert the medical and training staff prior to participation. No testing or screening equipment should be needed by schools, only treatment plans if a student has the genetic disorder.

Lightning is something that schools in Florida and Texas need to be wary of. During the thirteen year period from 1990-2003, 52 people died in Texas from lightning strikes putting the annual number of deaths in the general population at 4. The chances of death from lighting is one in 1,000,000. Schools in Texas are investing $6-$7K in early lightning detection systems to keep students safe. Events are delayed or cancelled. Participants and spectators are encouraged to seek shelter. Schools must develop an action plan because lightning will happen at some time while students are practicing, participating, or playing outside.

Sudden Cardiac Death is something that schools need to prepare for as well. In 2010 there were eight deaths from SCD in Texas. Given that there is no reporting mechanism by the state or the UIL it is difficult to track exact numbers.

Let's put things in perspective. Teen deaths are less than 1% of all deaths in the US. If a teen is going to die, the leading causes are

1. Auto accident (48% of all deaths)
2. Homicide (13%)
3. Suicide (11%)
4. Cancer (6%)
5. Heart Disease (3%)

From 1999-2006 there were 49.5 deaths per 100,000. This puts heart disease at 1.5 per 100,000 using the Center for Disease Control data. There are just over two million teenagers in Texas which means that there should be an average of 6 deaths per year in the teen population from heart disease.

I guess what I am getting at is that the SWATA Conference this year, the UIL Medical Advisory board for the past two years, the Texas Legislature, and the Texas Coaches Association have focused on the wrong things. Coaches have been focused on concussion screening since it was mandated by the Texas Legislature for most of 2011 and 2012 (relative risk 1:1,000,000). The UIL Medical board spent more time talking about restricting summer practices to avoid heat stroke (relative risk 1:1,000,000). SWATA invited in the leading expert on lighting and athletics to talk about planning and the value of a $7K warning system (relative risk 1:1,000,000). Nothing has been done or suggested by any of these organizations to help reduce the fifth leading cause of death, heart disease, for the school age population.

If schools are going to spend thousands of dollars on lightning warning systems, hundreds to thousands of dollars on baseline concussion screening, and hundreds to thousands of dollars to upgrade helmets and pads to reduce injury for one sport, spending $15-$25/student or asking parents to spend $15-$25/student for cardiac screening once while the student is in middle school and once while in high school should not be that much to ask. Event if money is the key issue, discussing the fact that current screenings with semi-annual physical questions, which are not used or wrong 87% of the time according to the University of Washington, warrants discussion by each of these groups. 

I guess that I am too passionate about this subject and am not seeing things clearly. If someone told me that there was a cheap and effective way to save five kids lives per year in Texas I would want to at least talk about it.