This survey assessed provider perceptions of sudden cardiac death (SCD) risk, screening practices for conditions associated with SCD, and current approaches to caring for high school aged patients. While SCD in children is a tragic event, we also acknowledge it is also a rare event, with more articles focused on SCD each year, including this study, than actual SCD in youth in competitive athletes. Although there is a wealth of recommendations from individual authors and organizations to our knowledge, this study represents the first assessment of what pediatric cardiovascular providers recommend in clinical practice.

Overall, the results of the survey do not support the practice of substantial additional screening in most high school students, with most providers recommending only routine physical examination and risk assessment questionnaire.

Most respondents did not feel that screening should be altered due to gender or race despite the data demonstrating differences in the performance of SCD screening (10) and the incidence of SCD in different populations (6, 8). The results provided in Table 2 suggest that our respondents have not included the data on differences in the incidence of SCD by sex (6) which may have influenced their recommendations. It is also possible that idea of providing differing levels of screening based on race and gender may itself have been unpalatable to respondents. Many more respondents felt that screening should be altered based on designation as a competitive athlete. This was particularly true of respondents who were not pediatric electrophysiologists, who were more than twice more likely to recommend ECG screening for athletes than non-athletes. Overall, respondents recommended an ECG in 41% and an echocardiogram in 9% of competitive athletes in comparison to 22% and 1% in those who are not competitive athletes. We appreciate that SCD is not restricted to competitive athletes and much of the published data cannot be generalized for the entire population.

This survey did not assess who would perform the screening tests, the potential for false-positive or false-negative results, or the associated costs of screening and subsequent testing. Unfortunately, the important topic of health equity of those screened was beyond the scope of this survey. Although minority of respondents reported moderate or greater concern about liability when interpreting ECGs in this setting, only 21.1% reported that they were unconcerned about this possibility.

There were several limitations to this survey. Although this data provide some insight into the recommendations of practicing pediatric cardiologists and pediatric electrophysiologists, the small sample size may be underpowered to detect important distinctions between pediatric cardiologists and electrophysiologists. Due to considerable overlap between members of AAP SOCCS and Pediheart we cannot calculate a response rate or evaluate for duplicate responses. Only a small number of EPs (n = 21) completed the survey. The results from this survey represent a minority of those who were invited and not everyone answered every question. Although the respondents represent a broad range of practice settings and geographic locations, we acknowledge the respondents do not necessarily represent the pediatric cardiology community as a whole. By definition, this study includes a sample bias toward those providers willing to participate in an online survey. Our results may also be skewed toward those with the strongest opinions on the topic.