Abstract 2441: Evolution Over 8 Years of the US Preparticipation Screening Process for Unsuspected Cardiovascular Disease in US High School Athletes
Introduction. Sudden death in young competitive athletes from cardiovascular disease is a major source of concern both to the medical and lay communities. Customary preparticipation screening in U.S. high schools consists of history-taking and physical examination to raise the suspicion of underlying cardiac disease with the potential for sudden death during sports. However, in 1997, the completeness and efficacy of this screening process was critiqued and called into question.
Methods. Now 8 years later, we have analyzed the changes in the 2005 approved history and physical questionnaires used in each state as a guide to the examiners and compared these forms to the 12 American Heart Association (AHA) recommended history and physical examination items in 1997.
Results. Nineteen states (37%) had clearly inadequate or rudimentary forms with only 0 – 4 AHA items, as compared to 2005 when only 4 states (8%) had such inadequate forms (p = < 0.001). Mean number of AHA items increased from 6.7 in 1997 to 10.1 in 2005 (p = < 0.001), an improvement of 66%. Over the 8-year period, the number of states allowing non-physician screening examiners increased substantially: nurse practitioners (21 to 41), physician assistants (21 to 39), naturopathic clinicians (1 to 7) and chiropractors (10 to 21); this represented an overall increase in chiropractor examiners of 150%. Between 1997 and 2005, 44% of states showed no or little change (addition of 0 –2 ≤ AHA items), while 56% showed substantial increase of ≥ 3 items, including 25% with a marked improvement by > 8 items.
Conclusions. The completeness of state-approved history and physical examination preparticipation questionnaires for high school students engaged in organized competitive sports has improved dramatically over the past 8 years. This development will undoubtedly result in the identification of greater numbers of student-athletes nationally with potentially lethal cardiovascular disease, affording the opportunity for risk-reducing therapeutic interventions. However, legislation permitting non-physician examiners (including chiropractors and naturopathic clinicians) has substantially increased.