In Reply: We agree with Drs Carek and Mainous
that the PPE, as performed at many institutions, may not adequately assess
risk for all of the causes of morbidity and mortality in the athlete population.
However, the specific objective of our study was to evaluate the utility of
screening questionnaires in detecting cardiovascular disease in athletes,
using the 1996 AHA guidelines1 as a criterion.
While the 1996 USPSTF Guide to Clinical Preventive Services is extensive, we found it devoid of information or guidelines directed
specifically toward the detection, in young athletic populations, of those
particular cardiovascular abnormalities known to be responsible for sudden
cardiac death on the athletic field,2 such
as hypertrophic cardiomyopathy2,3
and therefore does not appear to qualify as a criterion standard for medical
screening in all areas, as Carek and Mainous propose. Indeed, this was precisely
our purpose in designing the AHA guidelines for young athletes, which we believe
are superior and the most appropriate available criteria for our critique
of preparticipation cardiovascular screening.
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