Pfister G C, Puffer J C, Maron B J
Cardiovascular Research Division, Minneapolis Heart Institute Foundation, Minn 55407, USA.
JAMA. 2000;283(12):1597-9. doi: 10.1001/jama.283.12.1597.
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.
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 syndrome.
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 student-athletes.
年轻竞技运动员因未被察觉的心血管疾病而猝死，这引发了人们对参赛前筛查的更多关注。
评估在大学年龄的学生运动员中检测潜在致命心血管疾病的筛查做法。
设计、地点和参与者：1995年至1997年期间，对1110所美国国家大学生体育协会成员学院和大学进行了调查，879所（79%）回复了问卷。
从队医或体育主任处获取参赛前筛查过程的管理和范围信息；对参赛前筛查表格的内容进行评估，并与1996年美国心脏协会（AHA）共识小组筛查指南推荐的12项内容进行比较。
879所学校中有855所（97%）要求进行参赛前筛查，713所学校（81%）在校园内进行筛查，446所学校（51%）要求每年进行筛查。在713所进行校园筛查的学校中，603所（85%）由队医负责检查，不过其中135所学校（19%）也批准执业护士进行检查，244所学校（34%）允许运动训练师进行检查。在从625个机构分析的病史和体格检查筛查表格中，只有163所学校（26%）的表格包含至少9项AHA推荐的12项筛查指南内容，被判定为充分，而150所学校（24%）的表格包含4项或更少这些参数，被认为不充分。第三分区的小学校比第一分区的大学校更有可能有不充分的筛查表格（30%对14%；P<0.001）。超过40%的筛查表格遗漏的相关项目包括劳力性胸痛、呼吸困难或疲劳史；家族性心脏病或过早猝死；以及马凡综合征的身体体征或家族史。
许多美国学院和大学使用的参赛前筛查过程在检测（或引发怀疑）可能导致竞技学生运动员猝死的心血管异常方面的潜力可能有限。
