Abstract 9502: Is Auscultation the Achilles' Heel of Sports Screening? -Evidence on the Proficiency of Primary Care Physicians

Abstract

Background Preparticipation sports screening relies heavily on physical examination. Studies have shown that most sports preparticipation examinations are performed by non-cardiology physicians. The question we sought to examine was whether primary care physicians can reliably recognize heart murmurs and sounds including the murmur of hypertrophic cardiomyopathy.

Methods Primary care physicians attending a national meeting for internal medicine were examined on their ability to recognize basic murmurs including aortic stenosis, mitral regurgitation, and innocent systolic murmurs. In addition, extra heart sounds and the advanced murmur of hypertrophic cardiomyopathy were also examined. Murmurs and other heart sounds were played in random order on a torso showing the location of the stethoscope. Participants were required to identify the heart sounds on a blank sheet of paper as the pretest. All attended a 90 minute workshop on cardiac auscultation. Murmurs and heart sounds were randomly retested.

Results 1086 physicians participated in the pre and post testing. Average pretest score was 47% (range 36-54%). There was no difference whether testing was tested on basic murmurs, extra heart sounds or hypertrophic cardiomyopathy. Average posttest score was 77% (range 65-86%) (p <0.001 by paired t test).

Conclusions Primary care physicians perform the majority of sports screening in the US. They primarily utilize physical examination to determine safety for play. These data suggest common murmurs are often unrecognized. Murmur recognition is easily improved after a brief education. Additional studies should be aimed at identifying if this is sustained learning or whether continuous education for murmur recognition should be required for those performing sports screening.