Sudden cardiac death screening in adolescent athletes: an evaluation of compliance with national guidelines
Madsen NL, Drezner JA, and Salerno JC. Br J Sports Med. 2013;47:172-177.
Take Home Message: Less than half of physicians reported understanding the national guidelines for cardiovascular screening among athletes but even among those who reported an awareness of the guidelines many did not implement them.
The current gold-standard of screening high school athletes for sudden cardiac death (SCD) is the use of preparticipation physical evaluations (PPE). While the use of PPE’s is the gold-standard, it is not required before athletic participation is allowed. Further, it is unknown to what degree providers are in compliance with national consensus guidelines, in particular those put forth by the American Heart Association (AHA). Therefore, Madsen and colleagues evaluated in Washington state the state-wide awareness and compliance with the 2007 American Heart Association consensus guidelines on cardiovascular screening among athletes. The authors invited all members from the Washington Chapter of the American Academy of Pediatrics (776 members) and Washington Academy of Family Physicians (990 members) to participate in the study. High-school athletic directors in Washington state were also contacted through the Washington Interscholastic Activities Association. Surveys distributed to the medical organizations evaluated numerous aspects of PPE including, presence of a clinic-specific PPE form knowledge of the AHA cardiovascular screening guidelines, if they use the 12 elements of the AHA guidelines, and willingness to support a statewide universal PPE form. Surveys distributed to athletic directors included evaluation of presence of a school mandated or recommended PPE form satisfaction with the PPE, awareness of the AHA guidelines, and willingness to support a statewide universal PPE form. Additionally all contacted individuals were asked to provide a copy of any PPE forms which they use. Response rate from the three groups ranged from 56% (family physicians) to 78% (athletic directors). Overall, 47% of physicians, and 6% of athletic directors reported an understanding of the AHA guidelines, however only 5.7% of physicians were always in compliance. Physicians who reported an understanding of the AHA guidelines were more likely to be compliant with those guidelines. Additionally, 95% of physicians and 66% of athletic directors indicated a willingness to adopt a standard, statewide PPE
This study presents an interesting look into the understanding and implementation of PPEs. Overall, less than half of the physicians reported understanding the AHA guidelines but even among physicians who reported an awareness of the AHA guidelines many did not implement them. While it was not the purpose of the study, it would be interesting to gain a better understanding of why there is a lack of implementation. Conceivably, if we can understand the reason why these guidelines are not implemented then we could initiate efforts to enact change. Regardless of this missing information, the results suggest that physicians and athletic administrators need to be better educated on the guidelines and the significance of implementing them. Education about guidelines may be important beyond guidelines related to PPE since this is not the only study to suggest that the current guidelines are not being implemented. Other sources indicate that over 60% of pediatric neurologists do not use the current concussion guideline for clinical practice. It may be critical for clinicians in sports medicine to be more proactive about educating physicians and other healthcare providers in our local community about the current guidelines related to sports medicine. Another possibility for PPEs may be to adopt statewide PPE forms to promote implementation and compliance. Tell us what you think. As clinicians are you aware of the AHA guidelines? If so, are all guidelines and standards implemented? Why or why not?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
Madsen NL, Drezner JA, & Salerno JC (2013). Sudden cardiac death screening in adolescent athletes: an evaluation of compliance with national guidelines. British Journal of Sports Medicine, 47 (3), 172-7 PMID: 23118118