Profile of preparticipation cardiovascular screening for high school athletes
Profile of preparticipation cardiovascular screening for high school athletes
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DOI：
10.1001/jama.279.22.1817
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发表时间：
1998-06-10
影响因子：
120.7
通讯作者：
Maron, BJ
中科院分区：
文献类型：
--
作者：
Glover, DW;Maron, BJ
背景。-由于未被怀疑的心血管疾病而导致的年轻竞技运动员的猝死引起了人们对美国高中运动员可获得的运动筛查的关注和兴趣。为了评估潜在的充分性的cancipation筛选过程中检测或增加心血管异常的怀疑。对50个州和哥伦比亚特区的每个高中管辖区的现行指导方针和要求进行了分析，并与1996年美国心脏协会（AHA）共识小组指导方针进行了比较。准备筛查问卷中包含的项目;指定进行筛查的检查员。结果。-八个州（16%）没有批准的历史和体检问卷来指导检查人员，包括一个没有正式筛查要求的州。在剩下的43个州中，与心脏相关问题相关的几个项目经常从问卷中遗漏，呼吸困难或胸痛，既往运动限制，心脏病家族史或玛丽安综合征被纳入0%至56%的状态表格中。体格检查中的特定心血管项目仅包括5%至37%的状态，包括心脏杂音，心律不齐，外周脉搏或马凡氏综合征的痕迹。43个州中有17个州（40%）的历史和身体问卷被认为是最充分的，至少有13个AHA建议中的9个，而12个州（28%）的历史和身体问卷被认为是最不充分的，其中4个或更少的建议项目。因此，51个州中共有20个州（40%）没有经过批准的病史和体检问卷，或正式的筛查要求，或被认为不充分的表格。除了医生，21个州还允许护士或医生助理进行检查，11个州专门为心血管训练有限的从业者（如脊椎按摩师）提供服务。参与前运动筛查心血管疾病与标准的历史和体检，目前在美国高中，是高度依赖于国家批准的问卷，这往往是缩写，可能是不够的，是由各种不同的专业知识水平的卫生保健工作者实施，并可能严重限制其权力，以检测潜在的致命的心血管异常。这些观察结果应该是高中运动员心血管疾病筛查过程中变化和改进的动力。
Context.-Sudden death in young competitive athletes due to unsuspected cardiovascular disease has heightened concern and interest in the preparticipation screening available to high school athletes in the United States.Objective.-To assess the potential adequacy of the preparticipation screening process for detecting or increasing the suspicion of cardiovascular abnormalities.Design.-Current guidelines and requirements for implementation of preparticipation screening from each of the high school jurisdictions in the 50 states and the District of Columbia were analyzed and compared with the 1996 American Heart Association (AHA) consensus panel guidelines on screening.Outcome Measures.-Items contained on preparticipation screening questionnaires; the examiners designated to perform screening.Results.-Eight states (16%) have no approved history and physical examination questionnaires to guide examiners, including 1 state without a formal screening requirement. Of the remaining 43 states, several items relevant to cardiac-related problems were frequently omitted from the questionnaires, Exertional dyspnea or chest pain, prior limitation from sports, family history of heart disease, or Marian syndrome were included in 0% to 56% of the state forms. Specific cardiovascular items on physical examination were included in forms from only 5% to 37% of states, including documentation of a heart murmur, irregular heart rhythm, peripheral pulses, or stigmata of Marfan syndrome. Seventeen (40%) of 43 states had history and physical questionnaires judged to be most adequate with at least 9 of the 13 AHA recommendations, whereas 12 states (28%) were least adequate with 4 or less of these recommended items. Therefore, a total of 20 (40%) of the 51 states have no approved history and physical examination questionnaires, or formal screening requirement, or forms that were judged to be inadequate. In addition to physicians, 21 states also permit nurses or physician assistants to administer examinations, and 11 states specifically provide for practitioners with limited cardiovascular training (such as chiropractors).Conclusions.-Preparticipation athletic screening for cardiovascular disease with standard history and physical examination, as presently employed in US high schools, is highly dependent on the state-approved questionnaires, which frequently are abbreviated and may be inadequate; is implemented by a variety of health care workers with varying levels of expertise; and may be severely limited in its power to detect potentially lethal cardiovascular abnormalities. These observations should represent an impetus for change and improvement in the preparticipation cardiovascular screening process for high school athletes.