Sports Medicine Research: In the Lab & In the Field: Preparticipation Cardiovascular Screening among NCAA Division I Institutions (Sports Med Res)


Friday, February 22, 2013

Preparticipation Cardiovascular Screening among NCAA Division I Institutions

Preparticipation cardiovascular screening among National Collegiate Athletic Association Division I Institutions

Coris EE, Sahebzamani F, Curtis A, Jennings J, Walz SM, Nugent D, Reese E, Zwygart KK, Konin JG, Pescasio M, Drezner JA. Br J Sports Med.2013 Feb;47(3):182-4.

Sudden cardiac death has recently received considerable attention; however, experts and governing bodies are unable to agree on a unanimous screening protocol. At the center of the debate is whether we should incorporate electrocardiography (EKG) into preparticipation physicals (PPEs). While this debate lingers in remains unclear how sports medicine programs in NCAA Division 1 athletic programs are incorporating non-invasive cardiovascular screening (NICS) into PPEs. Therefore, Coris and colleagues sent out a survey to head athletic trainers of all NCAA Division 1 football programs and evaluated their use of routine NICS in NCAA PPEs. Among the 116 Division 1 programs, 74 (64%) head athletic trainers responded. Thirty-five (47%) head athletic trainers reported that they were already incorporating NICS in their PPE. More specifically, 31 of the 35 (91%) programs utilized routine EKG in PPE’s, while 17 (49%) programs relied on echocardiogram for evaluation of their athletes. This study also revealed that 22 (64%) of the participating programs use NICS only on incoming freshmen. Finally, 16 out of 38 (42%) programs that reported they do not engage in routine NICS screening suggested that cost is the main reason for not performing the screening regularly, while 13 (34%) stated that the AHA 2007 guidelines do not recommend routine NICS during PPE’s.

This non-uniform adoption of NICS reflects the current debate surrounding screening for sudden cardiac death risk in the athletic population. Professional athletic organizations (MLB, NFL, NHL, and NBA) have implemented mandatory screening, while at the college and high school level it is left to the discretion of the individual schools to implement such programs. Further, the AHA does not support NICS on a routine basis. This study most certainly addressed some of the barriers to NICS at the college level and cost issues were identified as the leading cause for not participating in routine NICS during PPE’s. It remains unclear if the actual number of programs not performing sudden cardiac death screening is higher, if all schools (e.g., Division 2 or 3), not only high profile collegiate programs were included? An interesting point was revealed in this study, that 64% of programs only screen incoming freshmen with NICS. Could this be a feasible alternative to provide broad screening and eliminate the obstacles of costs in the screening process? Do you conduct non-invasive cardiovascular screening in your PPEs? If so, how often does an athlete get screened?

Written by: Christian Glaser, DO and Marc I. Harwood, MD
Reviewed by: Jeffrey Driban

Related Posts:
Coris EE, Sahebzamani F, Curtis A, Jennings J, Walz SM, Nugent D, Reese E, Zwygart KK, Konin JG, Pescasio M, & Drezner JA (2013). Preparticipation cardiovascular screening among National Collegiate Athletic Association Division I Institutions. British Journal of Sports Medicine, 47 (3), 182-4 PMID: 22976912


Anonymous said...

Schools and sports teams should start employing new technology (like the HeartCheck PEN handheld ECG device or the ECG iphone app). These inexpensive devices can be used to help detect potentially lethal heart abnormalities.

Nic Philpot said...

I agree that sudden cardiac death is a very serious issue and should be addressed. That being said, I do not believe that there is a cost effective way to incorporate this into our PPE's. Division 1 colleges have the advantage in this area because cost is not always an issue for them. Many smaller colleges are struggling to meet the basic requirements with the budget that they are given. When a school has to cut back on the number of people that they are taping because they have no more money in the budget to get more tape, ECG's are just not a practical reality for them. As far as only testing the freshman, I believe that its a start. The heart is still changing at that time in their lives. So it is not the ultimate answer. They will get into better shape, and continue to mature and grow, and that will change the size of their heart which could lead to future problems after their freshman year.

Chris said...

I agree with your assessment that costs are a major limiting factor for cardiac screening in college athletes. This is a debate across the sports medicine community how to offset theses costs however at the present there are no good conclusions how to reach to this goal. Further studies need to be done to find the optimal time frame when to perform cardiac screening in college athletes, especially considering the ever changing physiology and anatomy of an athletes heart.

Jess Schlesman said...

I think it's a good idea to incorporate further cardiovascular tests into PPE's in all levels and divisions of athletics. Although it's very costly, smaller schools should not be neglected when it comes to such serious conditions. I believe cardiovascular conditions need to be payed more attention during PPEs.

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