Department of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Undergraduate Medicine, Queen's University, Kingston, Ontario, Canada.
Can J Cardiol. 2018 Jul;34(7):933-936. doi: 10.1016/j.cjca.2018.04.005. Epub 2018 Apr 12.
Pre-participation screening of athletes to prevent sudden cardiac arrest or death is endorsed by international guidelines. Standardized histories and physical examinations are recommended to optimize effectiveness. To assess current screening practices across Canada in the university athlete population, we sought to analyze the preparticipation screening form of all universities. A comparative analysis to recommendations from the American Heart Association (AHA), European Society of Cardiology (ESC), and the Preparticipation Physical Evaluation (PPE-4) was conducted. Pre-participation forms from 30 of 56 U Sports universities were obtained. Adherence to published guidelines was highly variable. Ten percent strictly followed any of the 3 guideline recommendations, and only 43% contained at least 75% of the recommended items. Average percentage adherence to AHA and ESC guidelines was statistically significantly higher than adherence to the PPE-4 (62.2% and 66.1%, respectively, vs 52.7%, P < 0.001). Family history of common cardiac conditions predisposing athletes to sudden cardiac death and family history of sudden or unexpected death was omitted in 80% and 30% of forms, respectively. Recommendations for examining for stigmata of Marfan syndrome and assessment of femoral pulses was absent on more than 70% of forms. Although there is great controversy regarding the benefits and impact of screening, our results suggest that Canadian universities are conducting pre-participation screening although in a highly variable manner. Incomplete and variable screening questionnaires employed by Canadian universities may negatively affect the potential to identify athletes with underlying disease. We recommend that, if pre-participation screening is performed, a guideline-based questionnaire be used to optimize accuracy.
运动员参加比赛前的筛查旨在预防心源性猝死或死亡，这一做法得到了国际指南的认可。建议采用标准化的病史和体格检查，以提高筛查的效果。为了评估加拿大各大学中大学生运动员群体的当前筛查实践情况，我们试图分析所有大学的参加比赛前筛查表格。我们对美国心脏协会（AHA）、欧洲心脏病学会（ESC）和参加比赛前身体评估（PPE-4）的建议进行了比较分析。我们获得了 30 所 U Sports 大学中的 30 所大学的参加比赛前筛查表格。对这些表格的分析发现，其对公布的指南的遵守情况存在很大差异。只有 10%的表格严格遵循了 3 项指南建议中的任何一项，只有 43%的表格包含至少 75%的推荐项目。AHA 和 ESC 指南的平均遵守百分比明显高于 PPE-4（分别为 62.2%和 66.1%，而 PPE-4 为 52.7%，P<0.001）。80%的表格省略了运动员易发生心源性猝死的常见心脏疾病家族史，30%的表格省略了家族性突发或意外死亡史。超过 70%的表格没有检查马凡氏综合征的特征和评估股动脉。尽管关于筛查的益处和影响存在很大争议，但我们的研究结果表明，加拿大各大学正在进行参加比赛前的筛查，但方式差异很大。加拿大各大学使用的不完整和可变的筛查问卷可能会对识别潜在疾病的运动员的能力产生负面影响。我们建议，如果进行参加比赛前的筛查，应使用基于指南的问卷，以提高准确性。
