Why Are 12-Leads Not Required For School Physicals

What happened to "studies don't prove something as fact???" :) The US has great healthcare... I see it firsthand.
 
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Oh what a tangled web we weave

18G said:
What happened to "studies don't prove something as fact???" :) The US has great healthcare... I see it firsthand.
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When we use propaganda to deceive.

http://www.ncbi.nlm.nih.gov/pubmed/21610339

http://www.ncbi.nlm.nih.gov/pubmed/17993963

http://www.ncbi.nlm.nih.gov/pubmed/18936372

http://www.ncbi.nlm.nih.gov/pubmed/19853754

http://www.ncbi.nlm.nih.gov/pubmed/17998346

http://www.ncbi.nlm.nih.gov/pubmed/18191781

there are a total of 2384 publications about this on pubmed. Maybe it is true?
 
18G said:
What happened to "studies don't prove something as fact???" :) The US has great healthcare... I see it firsthand.
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the first article wasn't a study. :)

Studies as proof rest in Preponderance of the Evidence.

Do you see other health systems healthcare first hand?

Does your anecdote supercede objective measure?

I would also point out that the first article was published in the number 1 US medical journal, by US experts, so maybe the insiders have a perspective on this that differs from yours?

Hate to pull the flag out from in front of your eyes, but the main thing US healthcare is #1 at is price.

I would also point out that second year death rates in a population have been used to qualify healthcare effectiveness in both medicine and anthropology. (2 seperate disciplines!)

In 2012 in order to find a place worse than the US, you would have to go to Africa. Even China and Russia do better. (Epic fail)

and before we talk about technically complicated medicine:

http://www.ncbi.nlm.nih.gov/pubmed/20883546

I have 11 more like it.

and somebody will inevitably say that wealthy people from the middle east always go to the US, but wealthy and smart are not =
 
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18G said:
What happened to "studies don't prove something as fact???" :) The US has great healthcare... I see it firsthand.
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If you are lucky enough to be able to afford it.
 
Sasha said:
If you are lucky enough to be able to afford it.
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If you can pay cash, you can have the same other places too. At a much lower cost.

The propaganda machine ever turns to passify the ignorant masses.

and don't be an elitist and get an education either...

I am looking for a study that compares the amount of people who leave the US for medical care compared to the amount that go to the US.
 
Here is an article regarding SCA in the NFL. None of these are scientific by any means but puts a broader perspective on the topic.
http://http://www.livingheartfoundation.org/suddencardiacdeath.pdf

"The electrocardiogram (1,282 players) revealed that more than 50% of these selected athletes had abnormal findings in spite of being asymptomatic and appearing fit. The prevailing opinion is that the electrocardiogram in young, asymptomatic, large-sized males is non-specific and sometimes misleading. The echocardiogram (156 players), a more sensitive testing method, showed that many of these football players showed hearts that were larger and thicker than accepted standards for people in the general population. The authors noted that these changes on echocardiogram were correlated with the playersí body size. The significance of these findings requires further serial testing and correlations with future clinical outcomes, before conclusions may be made."


Imagine if 50% of those 25,000,000 athletes were referred for further evaluation.

http://http://www.sca-aware.org/sca-news/nfl-may-mandate-heart-ultrasounds

This seems to be a case of falling through the cracks, but this particular athlete had numerous physical exams throughout his entire athletic career as well as en EKG performed at the combine but still died.

So even if every student athlete received an EKG or even an Echo for that matter, would it really have any drastic change in the number of deaths? Enought to justify it?

You stated this should be mandatory. What about the athlete who is informed of the risk and does not want to have an EKG but is forced into getting one which results in the discovery of some abnormality that may or may not ever cause an issue but is then benched losing his college scholarship or not drafted because a team does not want to risk it. But due to your paternalism you "potentially saved his life" but also ruined it at the same time. I know it's a very far fetched and slippery slope argument but I think the false positives can create a problem.


PS: I love the quote at the top of the page. "To save one life is as if to save the world" : I guess I am heartless and do not share the same opinion
 
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ChaseZ33 said:
PS: I love the quote at the top of the page. "To save one life is as if to save the world" : I guess I am heartless and do not share the same opinion
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If that one life is your son or daughter, than yes, that is the same as saving the world.
 
18G said:
If that one life is your son or daughter, than yes, that is the same as saving the world.
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That is just emotional bias and semantics. This is why the average person can be so easily convinced that this would be a great idea. Your tugging on heart strings to support something that most likely will have very little reduction of deaths.
 
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ChaseZ33 said:
That is just emotional bias and semantics. This is why the average person can be so easily convinced that this would be a great idea. Your tugging on heart strings to support something that most likely will have very little reduction of deaths.
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Yeah, and you know so much more than the cardiologists from the multiple studies advocating this, right?

It's not emotional bias when it's your kid. Do you even have kids? It's not something to be written off.
 
18G said:
It's not emotional bias when it's your kid.
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Yes, it is. That is the epitome of emotional bias.

Very interesting read. Why do I have the sneaking suspicion that OP is either a politician, or directly involved financially in pushing these ECG's?

Glad to see OP also seemed to learn the difference between there/their/they're, and your/you're towards the end!
 
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18G said:
Yeah, and you know so much more than the cardiologists from the multiple studies advocating this, right?

It's not emotional bias when it's your kid. Do you even have kids? It's not something to be written off.
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I don't think I need kids to determine that the above statement is an excellent example of letting emotions effect one's view on a practical issue.
 
For everyone on here that preaches the, "show me evidence, show me evidence".... studies are being done by leading pediatric cardiologists at major US hospitals and evidence is being provided yet people are still discounting the potential positives of this.

Is it absolute? No, and I'm not saying that at this point. Is the research going in that direction? I think so.

So what are the opinions of the studies that have been done recently on this issue? Are you all saying the research was flawed or done poorly?
 
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Tigger said:
I don't think I need kids to determine that the above statement is an excellent example of letting emotions effect one's view on a practical issue.
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You know there was a time when AED's in malls, office buildings and airports was deemed very impractical with much resistance against it? Some were saying defibrillation was an advanced skill, was dangerous for minimally trained people, etc, etc. Guess who was wrong??
 
18G said:
For everyone on here that preaches the, "show me evidence, show me evidence".... studies are being done by leading pediatric cardiologists at major US hospitals and evidence is being provided yet people are still discounting the potential positives of this.

Is it absolute? No, and I'm not saying that at this point. Is the research going in that direction? I think so.

So what are the opinions of the studies that have been done recently on this issue? Are you all saying the research was flawed or done poorly?
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There seems to be a few arguments going on. I am not saying that doing these EKGs would not have a positive outcome, I am arguing that the small potential positive outcome is not worth the cost. I do not agree with the "if we save one child it is all worth it" mentality. If I was some politican with $xxx,xxx,xxx to spend I wouldn't be looking to dump it into this.
 
ChaseZ33 said:
There seems to be a few arguments going on. I am not saying that doing these EKGs would not have a positive outcome, I am arguing that the small potential positive outcome is not worth the cost. I do not agree with the "if we save one child it is all worth it" mentality. If I was some politican with $xxx,xxx,xxx to spend I wouldn't be looking to dump it into this.
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And the thousands of $$$ for AED's and the maintenance contracts in schools is worth it for the small chance they may be needed? Why not just save the money and depend on EMS? If the patient dies oh well, it only happens on rare occasion.
 
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Good grief, it's exhausting reading through this thread.

"...coaches and athletic trainers to receive training in recognizing S/S that could progress to SCA and mandates pulling students from games who exhibit certain S/S..."

This is one of the more absurd quotes from this lengthy thread. I'm curious - what signs and symptoms could be recognized that could progress to SCA are there, besides SCA? Seriously?

Anyway - there are a lot of emotional arguments floating around - "saving even one life is worth the cost" sounds very noble - but in this day and time, you're going to have to REALLY justify the cost. And that's only going to get more and more difficult with Obamacare on the horizon. Here's an option I haven't seen mentioned:

My son started playing high school football the year after one of our athletes died from SCA due to previously undiagnosed cardiomyopathy. This happened about 10 years ago. At that time, AED's were not routinely available in our public schools, nor was any kind of routine screening of athletes. To say that we had a vested interest in "doing something" would be a gross understatement. Athletes, coaches, and athlete families were affected by this tragedy for years.

Our solution at our local high school went something like this. I realize it won't work everywhere, but it worked for us. The first thing that happened following this was to purchase AED's for the school (there were none on-site). They are fairly readily available any time of the day that school is in session, and immediately available for all events. For football, which for better or worse is the big money sport, an ambulance is present for every game, along with a few thousand fans. If we can't get the local public or private EMS service to do their "stand by" at our games, the booster club will foot the bill to make it happen.

Every athlete in Georgia high schools is required to have an annual physical exam by their physician. If anything is going to be mandatory, this is it.

And finally, for our program, every athlete is offered the opportunity to have an echocardiogram done when they start their athletic career. It's totally optional, but many take advantage of it. The cost is $75 total for exam, tech, and interpretation by a cardiologist. Parents pay for the exam, and if they can't afford it and want it, it magically gets taken care of. We refer a few athletes each season for follow-up. I would guess we do about 100 exams per year for our large high school.

Obviously nobody is making any real money off this program, and the charge is drastically reduced from what a hospital or cardiologist would normally charge. It's voluntary, but available to all regardless of ability to pay. I'm aware of other schools that strike a deal with a local hospital to run similar programs, with the hospital of course getting a ton of free publicity and "sponsor" status for various sports.

Mandatory screening with EKG / echo ? I dunno, I'm not convinced - but the peace of mind was well worth the $75 it cost us 9 years ago. I'd do it again in a heartbeat.
 
jwk said:
And finally, for our program, every athlete is offered the opportunity to have an echocardiogram done when they start their athletic career. It's totally optional, but many take advantage of it. The cost is $75 total for exam, tech, and interpretation by a cardiologist. Parents pay for the exam, and if they can't afford it and want it, it magically gets taken care of. We refer a few athletes each season for follow-up. I would guess we do about 100 exams per year for our large high school.

Obviously nobody is making any real money off this program, and the charge is drastically reduced from what a hospital or cardiologist would normally charge. It's voluntary, but available to all regardless of ability to pay. I'm aware of other schools that strike a deal with a local hospital to run similar programs, with the hospital of course getting a ton of free publicity and "sponsor" status for various sports.

Mandatory screening with EKG / echo ? I dunno, I'm not convinced - but the peace of mind was well worth the $75 it cost us 9 years ago. I'd do it again in a heartbeat.
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I like this solution. Educating the students and parents first and offering the screening at a reduced costs sounds reasonable. At least parents and students are informed of the risks and given the chance to have the screening which is better than playing off ignorance and not even giving the family a chance to decide for themselves.

As far as S/S to recognize, they are referring to dyspnea, dizziness, chest pain, syncope, stuff like that.
 
18G said:
For everyone on here that preaches the, "show me evidence, show me evidence".... studies are being done by leading pediatric cardiologists at major US hospitals and evidence is being provided yet people are still discounting the potential positives of this.

Is it absolute? No, and I'm not saying that at this point. Is the research going in that direction? I think so.

So what are the opinions of the studies that have been done recently on this issue? Are you all saying the research was flawed or done poorly?
Click to expand...

18G said:
For everyone on here that preaches the, "show me evidence, show me evidence".... studies are being done by leading pediatric cardiologists at major US hospitals and evidence is being provided yet people are still discounting the potential positives of this.

Is it absolute? No, and I'm not saying that at this point. Is the research going in that direction? I think so.

So what are the opinions of the studies that have been done recently on this issue? Are you all saying the research was flawed or done poorly?
Click to expand...

My reservation isn't about not helping, it is how much is it going to cost and how much damage will it do for any benefit?

If a parent wants their kid to have an EKG today, for piece of mind, for protection, etc. There is nothing that stops them from getting one.

But as cold as it sounds, costing millions if not hundreds of millions to save a handful of people per year is just not realistic.
 
Veneficus said:
But as cold as it sounds, costing millions if not hundreds of millions to save a handful of people per year is just not realistic.
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It doesn't sound cold, it sound entirely sensible. There is no health system in the world (as far as I am aware) that does not have to ration the health dollar. Spending enormous amounts of money screening a population that is, almost by definition, low risk makes no sense whatsoever.

I'm becoming increasingly convinced that any screening program causes more problems than it solves. One only has to look at the debacles of mammography or PSA screening to see that. Or closer to home for us EM types, the delightful saga that is PE diagnosis.
 
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