Sudden death in young competitive athletes due to unsuspected cardiovascular
disease has heightened interest in preparticipation screening.
To assess screening practices for detecting potentially lethal cardiovascular
diseases in college-aged student-athletes.
Design, Setting, and Participants
A total of 1110 National Collegiate Athletic 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 preparticipation
screening process was obtained from the team physician or athletic director;
preparticipation screening forms were evaluated for content and compared with
12 items recommended by the 1996 American Heart Association (AHA) consensus
panel screening guidelines.
Preparticipation screening was a requirement at 855 (97%) of 879 schools,
was performed on campus at 713 schools (81%), and was required annually by
446 schools (51%). Team physicians were responsible for examinations at 603
(85%) of 713 schools with on-campus screening, although 135 of these schools
(19%) also approved nurse practitioners and 244 schools (34%) allowed athletic
trainers to perform examinations. Of the history and physical examination
screening forms analyzed from 625 institutions, only 163 schools (26%) had
forms that contained at least 9 of the recommended 12 AHA screening guidelines
and were judged to be adequate, whereas 150 (24%) contained 4 or fewer of
these parameters and were considered to be inadequate. Smaller 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 premature sudden death; and physical stigmata or family history of Marfan
The preparticipation screening process used by many US colleges and
universities may have limited potential to detect (or raise the suspicion
of) cardiovascular abnormalities capable of causing sudden death in competitive