P2A096: Utilization of AAP Recommended Cardiac Screening Questions in Preparticipation Physical Evaluation Forms

Background: Annual preparticipation physical evaluation (PPE) forms are a tool for identifying potential cardiac disease in adolescents prior to high school athletics. In 2019, the American Academy of Pediatrics (AAP) recommended 10 screening questions to assess cardiovascular risk factors, including personal and family history that may suggest potential causes of sudden cardiac death. National implementation of these recommendations has not yet been evaluated. This study sought to evaluate utilization of the AAP screening questions within PPE forms from each of the 50 state high school athletic associations. It was hypothesized that most states would include all 10 screening questions.

Methods: PPE forms were acquired from the public website of each state high school athletic association. Forms were scored by two reviewers based on inclusion of recommended screening questions. Screening questions not included verbatim as published were considered sufficient if they incorporated all key descriptive terms, maintained the intended scope of focus, and avoided increasing false negative screening results. PPE forms from other sources, including parochial, private, or independent organizations, were excluded.

Results: PPE forms were obtained from 48 states. The two remaining states, Vermont and New Hampshire, defer PPE forms to individual school districts. Of the 48 PPE forms, 23 (48%) incorporated all 10 screening questions, 7 (14%) included 7-9 screening questions, and 18 (38%) included 6 or fewer screening questions. The 3 screening questions most commonly absent or insufficiently represented were: “Does your heart ever race, flutter in your chest, or skip beats during exercise?”, “Has a doctor every told you that you have any heart problems?”, and “Do you get lightheaded or feel shorter of breath than expected during exercise?” (omitted in 50%, 35%, and 35% of all forms, respectively). The only screening question present across all PPE forms was: “Have you ever had a seizure?” Inclusion of screening questions did not vary by state population (x2 = 0.24, p = 0.62); however, a difference was observed among geographical regions (x2 = 8.9, p = 0.03). States in the Midwest had the highest percentage of PPE forms with all 10 screening questions (75%), with the lowest percentage of states in the Northeast (11%).

Conclusion: Currently, a minority of high school athletic association PPE forms across the United States include all 10 AAP recommended cardiac screening questions. Incorporation of AAP recommendations did not vary by state population; however, geographic trends were observed. This study suggests opportunity for further collaboration between pediatricians and state high school athletic associations to improve screening for cardiac conditions among all adolescents.