Objective: Evidence on the increased risk of sports-related sudden cardiac
arrest and death (SCA/D) and the potential benefit of cardiovascular preparticipation
screening (PPS) in children is limited. We assessed the burden and circumstances of
SCA/D and the diagnostic yield of cardiovascular PPS in children aged 8-15 years.
Methods: Data on the incidence and causes of SCA/D from 2011 to 2020
were obtained from the Veneto region (Italy) sudden death registry, hospital records
and local press. During the same period, we assessed the results of annual PPS in
25 251 young competitive athletes aged 8-15 years who underwent 58 185 evaluations
(mean 2.3/athlete) in Padua, Italy. Results: Over 10 years, 26 SCA/D
occurred in children aged 8-15 years in the Veneto region: 6 in athletes (incidence
0.7/100 000/year, all >= 12 years) versus 20 in non-athletes (0.7/100 000/year, 17/20
>= 12 years). In total, 4/6 athletes versus 1/20 non-athletes survived. The cause
of SCA/D remained unexplained in four athletes and in nine non-athletes. No athlete
suffered SCA/D from structural diseases potentially identifiable by PPS. The incidence
of SCA/D in athletes and non-athletes was 0.2/100 000/year in the 8-11 years group
versus 1.3/100 000/year in the 12-15 years group. PPS identified 26 new diagnoses
of cardiovascular diseases (CVDs) at risk of SCA/D, more often in children >= 12 years
old (0.06%/evaluation) than <12 years old (0.02%/evaluation, p=0.02). Among athletes
with a negative PPS, two suffered unexplained SCA/D during follow-up, one during exercise.
Conclusions: In children aged 8-15 years, the incidence of SCA/D and
the yield of PPS for identifying at-risk CVD were both substantially higher in those
>= 12 years, suggesting that systematic PPS may be more useful beyond this age.
