What's new in the other general journals

Big US sports leagues screen their players for heart disease

Sudden unexpected deaths among elite professional athletes are rare, but do professional clubs do anything to try and prevent them? The American Heart Association recommends a thorough history, family history, and physical examination for all athletes before they compete, and a survey of all 122 US teams from the basketball, hockey, football, and baseball leagues shows that most of them make a reasonable effort to identify any athletes with potentially life threatening conditions such as cardiomyopathies, Marfan's syndrome, or coronary heart disease. All the athletes in the teams surveyed were interviewed and examined every year by a team doctor, and almost all of them had blood tests for serum lipids (108/122 (89%) of teams) and an electrocardiogram (112/122 (92%)). Fewer than one in five of the teams screened their athletes using echocardiography or stress testing, however, and the most comprehensive screening strategies were reserved for elite basketball players.

There's only limited evidence that screening athletes actually saves lives. The best comes from Italy, where screening based on history, examination, and electrocardiography has been mandatory for all competing athletes since 1982. The incidence of sudden cardiovascular death among screened athletes in the Veneto region has since fallen from 3.6/100 000 person-years to 0.4/100 000 person-years (test for trend, P < 0.001), driven largely by fewer deaths from cardiomyopathy (JAMA 2006;296: 1593-601).

Diagnostic errors are a common cause of litigation among US outpatients

In the outpatient setting, diagnostic mistakes that harm patients are common, complex, and deadly, according to a study of malpractice claims from four big US medical insurers. Missed, delayed, or wrong diagnoses that directly harmed the patient accounted for 59% (181/307) of all claims made by outpatients, and 30% resulted in death. Failure to take a proper history and examination, order the right test, or follow up the patient properly were the commonest diagnostic mistakes. Patients …