Doctors Warn of Improper Screening of Athletes
Health screenings that could detect the risk of sudden cardiac death in student athletes either don't exist or aren't detailed enough in many states and should be standardized nationally, a study in the Journal of the American Medical Association concludes.
For the study, published last week, two physicians surveyed directors of high school athletic associations in all 50 states and the District of Columbia. They determined that health questionnaires, which most schools require students to complete before they participate in sports, are often inadequate for detecting students' heart problems. And the school employees who sign off on student health forms, the article says, range widely in position and levels of expertise.
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Read the abstract of the JAMA article.
"Sudden deaths in young competitive athletes have become highly visible events that cause great public concern," write the authors, Dr. David W. Glover of St. Luke's Hospital in Kansas City, Mo., and Dr. Barry J. Maron of the Minneapolis Heart Institute Foundation. "Athletic-field catastrophes have stimulated considerable interest," they note, in identifying potentially lethal heart problems.
Such deaths are rare, the authors add, occurring in about one in every 200,000 student athletes.
The Kansas City, Mo.-based National Federation of State High School Associations, an umbrella organization for athletic governing bodies, recommends that schools require students to obtain a detailed health screening before participating in school sports. But individual state associations are free to devise their own policies.
Consequently, "each state association has varying rules," said Jerry L. Diehl, an assistant director of the federation. He added that some states allow districts to come up with their own health-screening policies.
Such is the case in Rhode Island, according to the JAMA study, where there is no state requirement for physical examinations for student athletes. Other states, the article says--including California, Georgia, Maine, and Oregon--don't have recommended physical questionnaires on hand to serve as guidelines for schools and districts.
Richard B. Lynch, the executive director of the Rhode Island Interscholastic League, said that though there is no state mandate, all schools in the state require that student athletes get physicals.
He added that his organization is preparing to issue a health-screening questionnaire, which schools can begin using in the fall, that was put together by a panel of experts on sports medicine.
On the other end of the policy spectrum are states like New Jersey, where, according to Boyd A. Sands, the executive director of the New Jersey State Interscholastic Athletic Association, state law requires that students receive a detailed physical exam before playing sports.
"There's a real emphasis on sports medicine here," Mr. Sands said. Most New Jersey high schools have a full-time, certified athletic trainer on staff to work with coaches and students, he added.
The authors of the JAMA study compared states' health-screening questionnaires against 13 recommendations for cardiovascular screening made by the American Heart Association. These included questions on family history of heart attacks or heart disease and personal history of heart murmur, hypertension, excessive fatigue, fainting, labored breathing, or chest pain.
Seventeen states, the article says, had questionnaires with at least nine of the 13 recommendations. But questions deemed essential for detecting abnormalities were missing from more than half the state forms.
"Physical-examination forms often demonstrated limitations that could reduce the chances for detecting or suspecting cardiovascular disease during the screening process," the authors write. "It is reasonable to expect that improvement and optimization of the preparticipation screening process will permit more frequent detection" of factors associated with sudden death in young athletes.
"We suggest that serious consideration be given to national standardization of the history and physical-examination form for preparticipation screening," they conclude.
Vol. 17, Issue 40, Page 3Published in Print: June 17, 1998, as Doctors Warn of Improper Screening of Athletes