Date of Award
Master of Physician Assistant Studies (MPAS)
Physician Assistant Studies
pre-participation physical examination; sudden cardiac death; hypertrophic cardiomyopathy; electrocardiography; athletes; death, cardiac, sudden; electrocardiography, screening; cost-benefit analysis
Inclusion of screening electrocardiograms (EKGs) during pre-participation physical examination has been a topic of debate for some time. There is unquestioned usefulness in the ability of a well-trained health care provider in using EKG to identify cardiac abnormalities. Further, there have been several contemporary EKG criteria published that increase specificity and sensitivity of detection of disease. However, these criteria do not account for athletes less than 14 years of age, and that demographic represents a large portion of patients seeking pre-participation screenings in the United States. The lack of research into pediatric cardiac remodeling secondary to activity, coupled with the significant overlap in normal pediatric EKG findings with adult pathological EKG findings create a difficult position for any health care provider. A literature review was performed to determine if screening EKGs are effective both medically and economically in athletes less than 14 years of age. Based on the review, the limitations of contemporary EKG criteria, the inability to prove cost effectiveness in the US healthcare model, and the lack of research into activity modulated pediatric cardiac remodeling should reinforce that the ACC/AHA checklist is an appropriate foundation for conducting pre-participation physical examination.
Pietrusza, Steven Jacob, "Pre-Participation Physical Examination: Are Current Cardiovascular Recommendations Enough?" (2018). Physician Assistant Scholarly Project Papers. 19.