Do student athletes benefit much from routine exams? One physician says yes.

It’s a longstanding back-to-school rite: The aspiring student athlete gives school authorities the medical forms that announce he or she has been seen by a doctor and is fit to play for a team.

We family physicians and pediatricians perform some 10 million of these examinations a year. And while we are doing a general checkup, our primary goal is to find serious conditions, most notably those that could result in sudden cardiac arrest and death.

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The specter of a seemingly healthy young athlete suffering a fatal attack during training or competition pervades the pre-participation examination, or PPE.

Such tragedies are extremely rare but they are very alarming and usually very public. The death in March of 16-year-old Wes Leonard, a Michigan basketball player who collapsed in front of a cheering crowd minutes after hitting a game-winning shot, made national news, sending a chill down the spines of millions of parents, coaches and doctors.

Virtually all schools require PPEs. Yet, while I routinely perform the tests, I always end up asking myself: “Am I really preventing someone’s death here?”

The answer, according to many experts and scientific studies: Probably not.

Which raises the question: Are the examinations worth doing?

Accuracy is an issue

Most often, sudden deaths among student athletes can be attributed — post mortem — to hypertrophic cardiomyopathy, a condition in which the heart muscle is enlarged or in some other way abnormal. So of course, if we can screen for HCM, we should do so.

The problem is that we can’t, at least not with the high degree of accuracy that most parents seem to assume we possess. A 2005 review of several studies about such exams, published in the Journal of Family Practice, found no good evidence “that demonstrates they reduce morbidity or mortality.” One study of the sudden deaths of 158 trained athletes age 35 and younger reported that 115 of them had had a PPE; the heart abnormality resulting in death had been identified in only one person. Detecting heart disease in the very young — for example, students of high school age — is tricky: Warning signs that may be present in an older patient are not always obvious.

Screening for the condition, says Barry Maron, a leading authority on hypertrophic cardiomyopathy based at the Minneapolis Heart Institute Foundation, is “much more complicated than most people think.”

In 2006, however, Italian researchers said they had found an examination that might be effective: the EKG, or electrocardiogram, which records the electrical pulses of the heart.

In a study reported in the Journal of the American Medical Association, the researchers examined the rates and causes of sudden cardiac death among more than 42,000 people aged 35 and younger between 1979 and 2004. Over the 26 years of the study, they reported a startling 89 percent decrease in the annual rate of such deaths among athletes who had been screened with an exam based on an EKG. Among unscreened non-athletes, the rate did not change significantly.