Cardiovascular Preparticipation Screening Practice of College Team
Physicians
Physicians
Asplund CA and Asif IM.
Clin J Sports Med. 2014; [Epub ahead of print].
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.
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.
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.
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?
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
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Asplund CA, & Asif IM (2014). Cardiovascular Preparticipation Screening Practices of College Team Physicians. Clinical Journal of Sport Medicine PMID: 24451693
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.
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.
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.