Clinical Scorecard: Evaluating the Effects of Preparticipation Screening Protocols on Health Equity Among College Athletes

At a Glance

Key Highlights

• SCD is the leading medical cause of death among college-age persons with similar rates in athletes and non-athletes.
• Preparticipation screening with ECG plus history and physical exam improves detection sensitivity and cost-efficiency compared to history and physical exam alone.
• Health equity concerns arise as screening programs often exclude non-athletes and are impacted by disparities in access to care and institutional resources.

Guideline-Based Recommendations

Diagnosis

• Use a 14-point history and physical exam to capture cardiovascular risk factors though sensitivity is low.
• Combine ECG with history and physical exam to improve sensitivity and cost-efficiency for detecting cardiac abnormalities.
• Apply updated ECG interpretation criteria (e.g., Seattle criteria) to reduce false positives.

Management

• Follow guidelines from the American Medical Society for Sports Medicine (AMSSM) for cardiovascular evaluation and rapid response to SCD events.
• Tailor screening strategies to local resources while acknowledging potential health inequities.

Monitoring & Follow-up

• Conduct secondary investigations after abnormal screening results to confirm diagnoses.
• Monitor for physiologic and psychological impacts on athletes undergoing screening.

Risks

• False positives from ECG screening can lead to unnecessary testing and psychological burden.
• Disparities in access to screening may exacerbate health inequities, particularly among underserved populations.

Patient & Prescribing Data

College athletes undergoing preparticipation cardiovascular screening

ECG combined with history and physical exam is more effective and cost-efficient in detecting cardiac abnormalities linked to SCD than history and physical exam alone.

Clinical Best Practices

• Incorporate ECG screening alongside history and physical exam to enhance detection of cardiac abnormalities.
• Use standardized ECG interpretation criteria to minimize false positives.
• Address health equity by expanding screening access beyond athletes to include non-athletes at similar risk.
• Provide additional resources for medically underserved populations and institutions with limited budgets.
• Recognize and mitigate structural and social determinants of health that affect access to cardiac screening.

References

• 2015 Meta-analysis on sensitivity of history and physical exam
• Study on cost-efficiency of H&P plus ECG
• ECG interpretation expertise and false positive rates
• Seattle criteria for ECG screening
• AMSSM 2016 preparticipation screening guidelines
• Health equity concerns in ECG screening
• Structural racism and healthcare disparities in the USA
• Feasibility and affordability of large-scale screening
• Impact of institutional budgets on athlete medical care