Ecg Use In Pre-participation Physicals For High School And College Athletes

PURPOSE/BACKGROUND: The most common cause of mortality for high school and college athletes during exercise is sudden cardiac death (SCD) which occurs at a rate of approximately 1.25/100,000 athletes per year. Most levels of student athletics require some degree of physical assessment prior to participation. However, pre-participation exams (PPEs) lack standardized cardiovascular screening. Several studies have demonstrated that obtaining screening ECGs for athletes during PPEs outperformed the cardiovascular surveys used by some providers. The goal of this study is to gather information from 8 New England sports medicine fellowship programs regarding PPEs and cardiovascular screening. Specifically, we determined what information is collected and which services are provided during PPEs for cardiovascular screening. METHODS/APPROACH: An IRB approved survey regarding was sent to each of the New England based sports medicine fellowship directors. RESULTS: There was a 100% (8/8) response rate. The five programs who responded cover a total of 12 high schools, 11 NCAA D-III schools, two D-II schools, and six D-I schools. Five programs (62.5%) reported using a validated standard cardiovascular screening survey (AHA 14-point survey, PPE-4). All programs covering NCAA D-I schools reported using screening ECGs as part of their PPE requirements for some of their team coverage. All programs that performed screening ECGs reported partnerships with a cardiology practice to coordinate care for athletes. The most commonly perceived obstacles to implementing screening ECGs were “time/workflow” and “cost.” The only consistent cardiovascular component in PPEs throughout all participants was cardiac auscultation. DISCUSSION/CONCLUSION: Screening ECGs continue to be a point of controversy. Our study showed that Sports Medicine training programs are inconsistent in their use of ECGs for PPEs outside of select NCAA D-I sports. Although screening ECGs sensitivity and specificity have significantly improved and the false positive rates have decreased to less than 5% over the past 10 years with the refinement of ECG interpretation in the athlete, practices do not seem to have changed. Studies investigating the cost-benefit analysis for more sensitive screening ECGs in athletes are needed.