Profile of Preparticipation Cardiovascular Screening for High School Athletes

CONTEXT: Sudden death in young competitive athletes due to unsuspected cardiovascular disease has heightened concern and interest in the preparticipation screening available to high school athletes in the United States. OBJECTIVE: To assess the potential adequacy of the preparticipation screening process for detecting or increasing the suspicion of cardiovascular abnormalities. DESIGN: Current guidelines and requirements for implementation of preparticipation screening from each of the high school jurisdictions in the 50 states and the District of Columbia were analyzed and compared with the 1996 American Heart Association (AHA) consensus panel guidelines on screening. OUTCOME MEASURES: Items contained on preparticipation screening questionnaires; the examiners designated to perform screening. RESULTS: Eight states (16%) have no approved history and physical examination questionnaires to guide examiners, including 1 state without a formal screening requirement. Of the remaining 43 states, several items relevant to cardiac-related problems were frequently omitted from the questionnaires. Exertional dyspnea or chest pain, prior limitation from sports, family history of heart disease, or Marfan syndrome were included in 0% to 56% of the state forms. Specific cardiovascular items on physical examination were included in forms from only 5% to 37% of states, including documentation of a heart murmur, irregular heart rhythm, peripheral pulses, or stigmata of Marfan syndrome. Seventeen (40%) of 43 states had history and physical questionnaires judged to be most adequate with at least 9 of the 13 AHA recommendations, whereas 12 states (28%) were least adequate with 4 or less of these recommended items. Therefore, a total of 20 (40%) of the 51 states have no approved history and physical examination questionnaires, or formal screening requirement, or forms that were judged to be inadequate. In addition to physicians, 21 states also permit nurses or physician assistants to administer examinations, and 11 states specifically provide for practitioners with limited cardiovascular training (such as chiropractors). CONCLUSIONS: Preparticipation athletic screening for cardiovascular disease with standard history and physical examination, as presently employed in US high schools, is highly dependent on the state-approved questionnaires, which frequently are abbreviated and may be inadequate; is implemented by a variety of health care workers with varying levels of expertise; and may be severely limited in its power to detect potentially lethal cardiovascular abnormalities. These observations should represent an impetus for change and improvement in the preparticipation cardiovascular screening process for high school athletes.