Cardiovascular Screening in Pediatric Competitive Athletes: Prevalence, Risk Stratification, and Public Health Implications from a Regional Cohort in Georgia

Background: Sudden cardiac death (SCD) in children and adolescents is a rare but catastrophic event with substantial public health impact. A significant proportion of exercise-related SCD cases are attributable to previously undiagnosed structural or electrical cardiac abnormalities that may be detectable through systematic screening. Objective: To determine the prevalence, clinical spectrum, and risk stratification profile of cardiovascular abnormalities identified during structured preparticipation screening of pediatric competitive athletes in Adjara, Georgia, and to evaluate implications for sports safety policy. Methods: A cross-sectional cohort study was conducted in 2025 including 442 competitive athletes aged 7–18 years recruited through organized sports institutions in Adjara, Georgia. All participants underwent standardized cardiovascular evaluation including medical history, physical examination, electrocardiography, and echocardiography. Detected abnormalities were categorized into risk groups for sudden cardiac death. Results: Cardiovascular abnormalities were identified in 13.1% of athletes, with high-risk conditions detected in 0.45% of the cohort. The number needed to screen to detect one high-risk condition was 221 athletes. Conclusion: Structured cardiovascular screening identifies clinically relevant abnormalities in pediatric athletes and provides essential evidence to inform context-sensitive public health policy and sports safety strategies. Keywords: pediatric athletes; sudden cardiac death; cardiovascular screening; electrocardiography; echocardiography; risk stratification; sports cardiology; public health policy