Cardiovascular Preparticipation Screening Practice of College Team

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

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

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

Written by: Kyle Harris
Reviewed by:  Jeffrey Driban

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