In this issue of JAMA, the article by Glover and Maron1
addresses the issue of improving the sensitivity of the preparticipation examination
(PPE) to detect silent, clinically important cardiovascular abnormalities
that place the athlete at risk for sudden cardiac death (SCD). Fortunately,
SCD is rare in high school athletes. But the appeal of being able to identify
risk factors and thereby prevent SCD, coupled with the legal obligation for
sports organizations and institutions to provide a safe environment for athletes
points to the need to consider, wherever possible, ways to improve the sensitivity
of the PPE. Glover and Maron have identified the following problems with the
high school PPE process: (1) 16% of states have no approved history and physical
examination forms; (2) of the 84% of states that do, questions deemed essential
for detecting abnormalities were missing from half of the history forms and
more than 60% of the physical examination forms; and (3) only 40% of the states
had questionnaires that incorporated the majority of 1996 American Heart Association
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