Best Practice Case Studies-Screening

Pdf Summary

The AMSSM position statement discusses cardiovascular (CV) preparticipation screening in young athletes, focusing on preemptively identifying cardiac conditions that could lead to sudden cardiac arrest or death (SCA/D). The standard screening involves a history and physical examination, but the potential addition of an electrocardiogram (ECG) is contentious. The report stresses that no single screening strategy fits all athletes due to varied risks and resource availability. Therefore, the decision to include ECG should be tailored by individual physicians based on specific athlete populations, community needs, and infrastructure resources.

Key points include:

1. <strong>Preparticipation Physical Evaluation (PPE):</strong> The PPE aims to ensure safe sports participation by assessing current and future health risks. However, its efficacy in preventing mortality is questionable, and it might fail to detect critical conditions without supplementary screening measures like ECG.

2. <strong>ECG Screening:</strong> ECG increases the likelihood of identifying certain cardiac conditions. Centers with ECG screening experience have improved detection rates and reduced false positives using modern interpretation guidelines. Yet, challenges like interpretation accuracy, false positives, and necessary cardiology support persist.

3. <strong>Incidence and Risk:</strong> Estimated annual incidences of SCA/D vary, with male African American college athletes and Division I basketball players having higher risks. There is currently a lack of definitive evidence indicating a general higher risk for athletes compared to nonathletes.

4. <strong>Potential Benefits and Risks:</strong> The overall benefit of early detection through screening must outweigh the associated risks, such as overdiagnosis and unnecessary interventions. Published studies have not shown major adverse outcomes from ECG screening in small cohorts.

5. <strong>Physician Autonomy and Recommendations:</strong> Due to the absence of conclusive outcomes data, no universal CV screening recommendation is endorsed. Instead, AMSSM encourages individualized physician assessment and community resource evaluation to implement effective screening strategies.

6. <strong>Emergency Preparedness:</strong> Regardless of screening measures, emergency action plans and access to automated external defibrillators are critical for improving survival rates from SCA.

Future directions highlighted by AMSSM include further research to address knowledge gaps in screening efficacy, the natural history of at-risk conditions, and strategic implementation of educational initiatives for improved screening accuracy.

Meta Tag

Edition 2nd Edition

Related Case 2nd Edition, CASE 05

Topic Cardiac

Keywords

2nd Edition, CASE 05

2nd Edition

Cardiac

cardiovascular screening

young athletes

sudden cardiac arrest

electrocardiogram

preparticipation evaluation

screening efficacy

athlete risk assessment

physician autonomy

emergency preparedness

AMSSM recommendations