Preparticipation cardiovascular screening for US collegiate student-athletes

Context Sudden death in young competitive athletes due to unsuspected cardi ovascular disease has heightened interest in preparticipation screening. Objective To assess screening practices for detecting potentially lethal ca rdiovascular diseases in college-aged student-athletes. Design, Setting, and Participants A total of 1110 National Collegiate Athle tic Association member colleges and universities were surveyed between 1995 and 1997, with 879 (79%) responding to the questionnaire, Main Outcome Measures Information on the administration and scope of the pr eparticipation screening process was obtained from the team physician or at hletic director; preparticipation screening forms were evaluated for conten t and compared with 12 items recommended by the 1996 American Heart Associa tion (AHA) consensus panel screening guidelines. Results Preparticipation screening was a requirement at 855 (97%) of 879 sc hools, was performed on campus at 713 schools (81%), and was required annua lly by 446 schools (51%), Team physicians were responsible for examinations at 603 (85%) of 713 schools with on-campus screening, although 135 of thes e schools (19%) also approved nurse practitioners and 244 schools (34%) all owed athletic trainers to perform examinations. Of the history and physical examination screening forms analyzed from 625 institutions, only 163 schoo ls (26%) had forms that contained at least 9 of the recommended 12 AHA scre ening guidelines and were judged to be adequate, whereas 150 (24%) containe d 4 or fewer of these parameters and were considered to be inadequate. Smal ler Division III schools were more likely than larger Division I schools to have inadequate screening forms (30% vs 14%, P<.001). Relevant items that were omitted from more than 40% of the screening forms included history of exertional chest pain, dyspnea, or fatigue; familial heart disease or prema ture sudden death; and physical stigmata or family history of Marfan syndro me. Conclusion The preparticipation screening process used by many US colleges and universities may have limited potential to detect (or raise the suspici on of) cardiovascular abnormalities capable of causing sudden death in comp etitive student-athletes.