Sports Medicine Research: In the Lab & In the Field: Cardiovascular Screening Practices in College Athletics has Room for Improvement (Sports Med Res)


Wednesday, February 26, 2014

Cardiovascular Screening Practices in College Athletics has Room for Improvement

Cardiovascular Preparticipation Screening Practice of College Team Physicians

Asplund CA and Asif IM. Clin J Sports Med. 2014; [Epub ahead of print].

Take Home Message: While many screening methods for sudden cardiac death exist, a large proportion of institutions do not employ noninvasive cardiac screening. The most commonly reported reasons why noninvasive cardiac screening is not used was lack of evidence to support its effectiveness and cost.

Sudden cardiac death is the most common cause of deaths during exercise. Unfortunately, there is still a debate about how to optimize cardiovascular preparticipation screening. If we could better understand how clinicians screen athletes and their perceived barriers to certain screening techniques then we could develop strategies to optimize our preparticipation screening. Therefore, Asplund and Asif conducted a cross-sectional survey study to determine the current cardiovascular preparticipation examination practices among college team physicians.  They also tried to determine what obstacles may impede the use of more advanced screening strategies. The researchers sent an electronic survey to all members of the American Medical Society for Sport Medicine, which includes sports medicine physicians, sports medicine fellows, primary care residents, and medical students. Two hundred and twenty four of the 613 (36.5%) college team physicians responded to the survey. Most of the respondents were NCAA division I team physicians (43%) and were from the Midwest (30%). Seventy-eight percent of respondents conducted the American Heart Association 12-element history and physical examination only. The other 22% of respondents completed the American Heart Association 12-element history and physical examination as well as a noninvasive cardiac screening (electrocardiogram or echocardiogram). Division I institutions were more likely to include noninvasive cardiac screening in their preparticipation screening (30%) compared with lower divisions. The 2 most commonly reported barriers for including noninvasive cardiac screening in Division I preparticipation screenings were lack of evidence (71%) and high cost of the test (64%). Among lower division schools cost effectiveness of noninvasive cardiac screening was also a major obstacle along with a need for more local expertise in athlete-specific interpretation of noninvasive cardiac screening results.

The current study presents clinicians with an interesting glimpse into the current cardiovascular preparticipation screening habits among colleges in the United States. While the data presented here may help inform clinicians about the current practices of cardiovascular preparticipation screening, one should exercise caution when interpreting this data. Unfortunately, this study did not collect any data regarding the incidence of sudden cardiac death. Without this data, it is difficult to inform clinicians of the effectiveness of the current screening methods. Further, only team physicians were surveyed. To gain a better understanding of the current habits, other member of the sports medicine team (athletic trainers, athletic directors, etc.) should also be surveyed. This would increase the generalizability of the data as the response rate of this study was only 37%. This low response rate leaves a large portion of team physicians unaccounted for. Until a more detailed analysis can be done, the data presented here should serve to encourage more research on the effectiveness of including noninvasive cardiac screening into preparticipation screenings as this was the most reported barrier. Furthermore, it may be helpful for schools near each other to coordinate their noninvasive cardiac screening to help lower costs for each institution. As we gain a better understanding of how to optimize our cardiovascular preparticipation screening we need to also consider these creative ways to reduce the cost of conducting these screenings.

Questions for discussion: What are you current cardiovascular preparticipation screening procedures? What role do you play in the sports medicine team and how do you influence what screening methods are use?

Written by: Kyle Harris
Reviewed by:  Jeffrey Driban

Related Posts:
Hypertension Among Collegiate Football Athletes – Too Much Pressure?

Asplund CA, & Asif IM (2014). Cardiovascular Preparticipation Screening Practices of College Team Physicians. Clinical Journal of Sport Medicine PMID: 24451693


Julia Giampaolo said...

I work at a division 1 program and our cardiovascular pre participation screenings are as follows. Each athlete completes extensive medical history documentation, of course including information regarding cardiovascular conditions. Each student athlete is required to receive an EKG. Blood pressure, pulse, auscultation and blood work are also included in the screening. All data must be reviewed by the team physician. All coaches and volunteer practice players are also screened. Blood work and EKG are not done in the yearly physical, but BP, pulse, and auscultation are. These procedures are pretty set in stone. As athletic trainers, we do not have much say in which screening methods are used in the pre participation exam, as all direction comes from the physician. However of course, if a cardiovascular condition is suspected we have the power to refer for whatever additional screening is necessary.

Kyle said...

Julia, thanks for your comment. First let me commend you on your institution's guidelines concerning this topic. Your screening methods are very good and it seems as though the entire sports medicine team works well together. I believe guidelines like that of your institutions will become fairly standard across the board as this research highlights the need. I think my big question to you would be; how much input do you believe you have in this in setting this procedure? Do you feel as though you could suggest EKGs as part of the yearly physical? Again thank you for the comment it's great hearing from different clinicians with so many different guidelines set up.

Rachel Koldenhoven said...

I recently graduated from a division I program. I was the student athletic trainer at the time. During my experiences as an undergrad, I worked with both division I and division III teams. At the division I level, athletes were required to receive an EKG along with other common preparticipation examination criteria (history, BP, HR). At the university, there were many resources available to the athletics department through the school of kinesiology. Unlike the division I school, the division III school I worked at did not require an EKG. It was a smaller school with fewer athletes. I don’t know the specifics as to why they did not require it, but it would probably be safe to assume that it was due to financial reasons.

As part of the sports medicine team, I was an athletic training student working under an athletic trainer. I didn’t have much say at all in how the preparticipation examinations were done and what procedures were used. I found that the more communication the athletic trainer had with the physician, the better they could come to agreements on these preparticipation requirements and screening methods they chose to use.

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