Herat risk screening inadequate in high school sports physicals: Study

By Dr. Ananya Mandal, MDNov 14 2011

Following incidents of deaths of high school athletes who collapse suddenly during practice or a game, new guidelines for screening athletes for hidden heart problems before the start of a season had been in place since 1996. About one of every 30,000 to 50,000 high school athletes dies each year from cardiac arrest.

A new study released Sunday however shows that the vast majority of doctors charged with such screenings don't follow the recommendations. Researchers at Seattle Children's Hospital and the University of Washington surveyed 1,113 pediatricians and family doctors and 317 high school athletic directors and found that fewer than half of the doctors and only 6% of the athletic directors were even aware of the guidelines.

The study also found only about 6% of the doctors fully follows the national guidelines for assessing sudden cardiac death risk. While doctors typically listen to young athletes’ hearts and record blood pressures, they often fail to ask important questions designed to ferret out heart disease risk. For example, 67 percent of surveyed doctors said they didn’t always ask teens whether any family members suffered from heart problems, 28 percent didn’t always ask if a teen had chest pain during exercise, 22 percent didn’t always ask if the teen ever experienced unexplained fainting and 26 percent didn’t always ask about a family history of early deaths

In 2007 the American Heart Assn. reaffirmed the guidelines, which consist of questions that are posed to the athlete as well as four physical exam elements. Key aspects of the screening process include asking whether the athlete has ever had chest pain during exercise or if he or she has a family history of heart disease or early death.

Dr. Gaurav Arora, associate director of electrophysiology at the Children’s Hospital of Pittsburgh and an assistant professor of pediatrics at the University of Pittsburgh said that the biggest surprise in the new study was the number of physicians who said they didn’t always ask about chest pain or fainting. “Those are red flags in young athletes,” said Arora,.

One explanation for the new findings is that there is no single form being used by doctors doing pre-season physicals for student athletes, Arora said. Things would be a lot simpler if everyone used the same screening criteria. Beyond that, Arora said, “we need better education across the board for all providers doing screening.”

“We need new directions to educate providers and improve policy requirements so patients can actually benefit from these national recommendations,” echoed the lead author of the study, Dr. Nicolas Madsen, a pediatric cardiology fellow at Seattle Children's Hospital.

The study was presented Sunday at the American Heart Assn. Scientific Sessions conference in Orlando, Fla.