File Name: sports medicine examination and board review .zip
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Corresponding Author: Rose Uzoma Elekanachi. The preparticipation physical examination PPE is an important area of the care and safety of any active athletic individuals.
The preparticipation evaluation was not made to prevent or exclude athletes from participation, rather to help athletes practice safe sport participation. There has been a long ongoing debate on the inclusion and importance of cardiovascular analysis as a part of the PPE as cardiovascular abnormalities is a risk factor that predisposes collegiate athlete to sport injuries or even death.
The objective of the proposed project was to identify the clinical methods that most effectively assess cardiovascular abnormalities in intercollegiate athletes through a systematic review of existing published research studies in which cardiovascular abnormalities in intercollegiate athletes were included as measurement variables. Sport-related injuries can have substantial impact on the long-term health of student-athletes.
Injuries can be sustained at any point in time, but during sport participation injuries are mostly sustained at the pre-season period or the in-season period In order to curb the incidence of sport injuries, the PPE was introduced to clear sport athletes before the season begins and confirms that the sport athlete was free from underlying factors that could predispose the athlete to sport injuries.
Maron et al, stated that the inconsistency of the different components of the PPE affected its effectiveness. The main objective when PPE is used, is to detect underlying or pre-existing conditions medical problems with life threatening complications that may predispose the athlete to life-threatening or disabling events due to inherited or acquired conditions.
Some countries make it a mandate that all competitive athletes undergo preparticipation screening, while in some countries it is recommended in order to prevent sudden cardiac issues in predisposed athletes In , La Grache et al. While the prevalence of some conditions, which are screened for such as coronary artery anomalies and long QT syndromes, are stable across different populations, the prevalence of underlying conditions such as hypertrophic cardiomyopathy and arrhythmogenic right ventricular dysphasia shows considerable geographic variability Therefore, justifying the need for a mandate on PPE in countries known for prevalent underlying conditions.
While the potential benefits of the PPE are substantial, there are numerous challenges with the process of administering the PPE that currently limit its effectiveness.
Foremost of these challenges is the continued use of non-uniform paper questionnaires that limit the ability to collect and analyze standardized data on millions of participants completing the PPE each year. Irrespective of the idea that the value of PPE is unknown, there are no indicators of a quick change on the PPE that makes a careful evaluation of athletes possible. The interest to measure the effectiveness of PPE is to determine its value and measure what the outcome would be if the data is collected electronically.
In , Matheson et al noted that an electronic questionnaire ideally would solve other problems for stakeholders, improving administrative efficiency, reduce cost, and streamline the PPE process. Researchers 13, 5, 6 have carried out studies on data, injury and illnesses among collegiate athletes and have reported the immense size of injuries and illness being reported during sport activities over the years.
There has been little or no record on prevention of these injuries or how participation of the collegiate athletes in Preparticipation evaluation have alleviated the occurrence of injuries and illnesses among collegiate athletes.
The history and physical examination by medical practitioner are unlikely to detect the prodromal signs and symptoms of cardiovascular abnormalities in many young athletes. Therefore, the objective of the proposed study is to identify the clinical method that most effectively assess cardiovascular abnormalities in collegiate athletes through a systematic review of existing published research studies in which cardiovascular abnormalities in intercollegiate athletes were included as measurement variables.
In this study, the PRISMA checklist and guidelines 16 was used to ensure the review of each research study was systematic and efficient, and the recording and reporting was accurate. Additionally, use of the PRISMA checklist and guidelines helped to ensure the transparency and validity of study findings Primary research studies in which the following keywords was used were included in the initial sample: Preparticipation evaluation PPE ; cardiovascular abnormalities; upper Extremity injury; collegiate athlete; injury risk assessment.
Studies in which risk of cardiovascular anomalies were measured using the PPE meet the inclusion criteria. Further screening and eligibility criteria was determined as studies were identified and in accordance with the PRISMA checklist and guidelines. After systematic review of studies that met the inclusion criteria, specific assessment data was extracted and a table containing the following data was created: purpose of the study, length of study time , sample size, average age of participants, and sex of participants, NCAA level, sport, cardiovascular abnormalities and risk factors.
The variability and estimated effect size of measures was also in this study. Finally, the strengths and weakness of the individual studies was documented in this study as well as its potential relevance of the results that were noted by the researchers. After the screening process was complete, 7 prospective studies which involved collegiate athletes were identified. Three studies were specific to young athletes under the age of 35 years, who were into different sports or sporting activities, 2 were specific to collegiate athletes who participated in different divisions under the governance of the National Collegiate Athletic Association NCAA , while 2 studies were specific to collegiate NCAA participating universities who have collegiate athletes participating in several sports.
Sample sizes ranges from , collegiate athletes and NCAA participating universities. The overall reports of Cardiac abnormalities from physical examinations ranged from 3. The most common screening for cardiovascular abnormalities included Preparticipation evaluation and 12 Lead Electrocardiogram but there is a constant debate on if there should be combination of both methods of just one based on resulting response to PPE. None of the prospective studies that met the inclusion criteria that were identified that involved evaluation of all parts or part of the clinical assessment recommended in the PPE fourth ed.
This review was able to identify several clinical examination modalities that have quite an initial evidence to indicate risk factors. Only 21 universities of all the division 1 universities in this study met the AHA recommendation by including all 12 cardiovascular screening on their PPE forms This conclusion was reported after examination of the preparticipation screening and prevention of sudden cardiac death in athletes: Implication for primary care.
The implementation of ECG testing will assist the decision whether to disqualify an athlete from participation because of pre-existing cardiac conditions, and ultimately preventing the untimely death of a young athlete Three different studies 12, in this review examined Preparticipation Evaluation PPE and prevention of sudden cardiac death in young collegiate athlete. The results proposed that most sudden cardiac death are due to silent cardiovascular diseases, and preparticipation screening of athletes at risk is thus of major Importance 8.
In , Maron et al reported that each condition known to be responsible for sudden cardiac death in young athletes occurs infrequently in the general population, ranging from the relatively common Hypertrophic Cardiomyopathy to much rarer conditions, such as congenital coronary artery anomalies, arrhythmogenic right ventricular dysplasia, ion channelopathies, and Marfan syndrome.
Scientific committees such as American College of Cardiology, the American Heart Association AHA and the European Society of Cardiology ESC and others as reported by Chartard et al, recommended a Preparticipation Screening PPS program also known as PPE to provide medical clearance for participation in competitive sports, all recommendations included questionnaires relating to family history, personal history as well as a physical examination.
However, the American Heart Association still does not recommend an ECG based on its numerous concerns including feasibility, cost-efficiency, prospect of high false positive results and the lack of physicians qualified to interpret ECGs These tend to be different with professional sports as stricter rules and regulations are upheld.
Figure 1 elaborately shows the different aspect of the PPE used for screening as reported by in by Borrione, P et al. Figure 1 shows the AHA recommendations for preparticipationcardiovascular screening of competitive athletes. In , Drezner et al in another study on the electrocardiographic screening in National Collegiate Athletic Association Athletes which involved 35 National Collegiate Athletic Association institutions and the screening involved both standard history, physical examination PPE as recommended by the American Heart Association and a lead electrocardiogram ECG at rest.
From the 5, athletes accessed from the 17 intercollegiate screened at least one positive cardiac symptom of family history response was reported by 1, athletes The false positive rate for history was It was then concluded that electrographic screening in National Collegiate Athletic Association athletes has a low false-positive rate and provides superior accuracy compared with standardized history and PE to detect athletes with dangerous cardiovascular conditions.
In this review, a feasibility study by Gleason et al on the early screening for cardiovascular abnormalities with preparticipation echocardiography using a cross-sectional design to compare 3 screening methods to identify cardiovascular abnormalities. The result of this study showed that the length of the time for screening was significantly shorter with limited PEFP All the 3 athletes with positive ECG findings and the 2 athletes with a borderline finding on limited PEFP were referred for formal evaluation with a cardiologist.
None of the 5 athletes were disqualified from competing after cardiac rehabilitation but one of the athletes with a positive screening-limited ECHO was determined to need annual monitoring. Gleason et al, concluded that incorporating limited PEFP into PPEs has the potential to limit the number of false-positive and false-negative cardiac sections which some researchers fear would occur if ECG or further testing modality apart from PPE was used to clear athletes.
Considering time-driven activity-based levels of cost analysis, limited as part of the PPE gives the highest value; the most accurate and reliable information and the lowest money and time expenditure. Cardiovascular abnormalities and sudden cardiac death assessment in college athletes and ways to identify and reduce its incidence has been a long-standing goal of sports medicine practitioners, coaches and athletic trainers. Some of the challenges that have been reported in developing a proper clinical assessment method for cardiovascular abnormalities have been the cost of effectiveness, feasibility when these assessments involve large populations of collegiate athletes, and diagnostic accuracy such as fear of false positive or false-positive results.
Several clinical assessment strategies have been proposed with variations of specificity to the given populations resulting in several results.
After an extensive review of the different literatures, that covered different sample sizes I found evidence that supported the use of PPE according to the AHA recommendation for cardiovascular screening for collegiate athletes.
The results of this review supported the use of the PPE as well as recommended that the process in which the PPE is completed, and the clearance methods which for some universities involved the athletes taken the PPE to be completed at home and cleared by a physician be reviewed.
As several researches used in this review identified that many universities do not use the component PPE as recommended by AHA. In addition to the personal and family history, a physical examination should be completed by a physician, nurse practitioner and athletic trainer that understands the 12 components of the PPE.
The combination of the PPE with an ECG screening has been seen to correctly identify collegiate athletes with risk of cardiovascular abnormalities and sudden cardiac death. The limitations of this review include; the diversity of the selected studies, also because this review was centered on cardiovascular abnormalities risk factors, the inclusion criteria had a respectively broad athlete or participating NCAA university population, including the direct comparison between clinical assessment modalities.
In conclusion, none of the prospective studies that were identified in this review refuted the use of the currently recommended sports PPE to access cardiovascular abnormalities in collegiate athletes as well as young competitive athletes. There are several evidences to support the generalized use of the PPE and assessment of personal history, family history, physical examination which are the point screening questionnaire for cardiovascular screening as recommended by the American Heart Association.
Administration of this questionnaire by qualified Physicians, Nurse practitioner or athletic trainers would give better and accurate results with a 12 lead ECG follow up to properly screen collegiate athletes of cardiovascular symptoms.
PPE Administration with 12 Lead ECG annually and an updated PPE with rest and stress ECG testing biannually may yield more benefits for prospectively evaluating cardiovascular abnormalities risk factors for collegiate athletes entering or participating in specific sports or positions of increased cardiovascular abnormalities risk exposure.
There has been a constant debate over the past few years on the most accurate and cost-effective way to administer the preparticipation evaluation to properly eliminate risk factors that could predispose sports athletes to sudden cardiac death. Previous Next. Data Collection and Reporting After systematic review of studies that met the inclusion criteria, specific assessment data was extracted and a table containing the following data was created: purpose of the study, length of study time , sample size, average age of participants, and sex of participants, NCAA level, sport, cardiovascular abnormalities and risk factors.
Clinical Journal of Sports Medicine ; Beth A. Borrione, P. Pre-participation screening for the prevention of sudden cardiac death in athletes. World journal of methodology , 3 1 , Physicians and Sports Medicine. Available on www. Accessed on September 27, Burns K. M, Encinosa W. E, Pearson G. D, Kaltman J. The Journal of Pediatrics ; 4 , Caswell, S. American Academy of Pediatrics , 1 , Cardiovascular screening practices in collegiate student-athletes.
PM R; 6 7 ; quiz Chatard J. C, Mujika I, Goiriena J. Scand J Med Sci Sports : doi: A, Owens D. S, Prutkin J. M, Salerno J. C, Harmon K. Am J Cardiol.
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Corresponding Author: Rose Uzoma Elekanachi. The preparticipation physical examination PPE is an important area of the care and safety of any active athletic individuals. The preparticipation evaluation was not made to prevent or exclude athletes from participation, rather to help athletes practice safe sport participation. There has been a long ongoing debate on the inclusion and importance of cardiovascular analysis as a part of the PPE as cardiovascular abnormalities is a risk factor that predisposes collegiate athlete to sport injuries or even death. The objective of the proposed project was to identify the clinical methods that most effectively assess cardiovascular abnormalities in intercollegiate athletes through a systematic review of existing published research studies in which cardiovascular abnormalities in intercollegiate athletes were included as measurement variables.
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