Evaluation of a Standardized Cardiac Athletic Screening for National Collegiate Athletic Association (NCAA) Athletes

Chanel E. Fischetti, MD; Reed W. Kamyszek, MD; Stephen Shaheen, MD; Benjamin Oshlag, MD; Adam Banks, MD; AJ Blood, MD; Jeffrey R. Bytomski, MD; Blake Boggess, DO; Shadi Lahham, MD, MS


Western J Emerg Med. 2019;20(5):810-817. 

In This Article

Abstract and Introduction


Introduction: Sudden cardiac death is a rare cause of death in young athletes. Current screening techniques include history and physical exam (H and P), with or without an electrocardiogram (ECG). Adding point of care cardiac ultrasound has demonstrated benefits, but there is limited data about implementing this technology. We evaluated the feasibility of adding ultrasound to preparticipation screening for collegiate athletes.

Methods: We prospectively enrolled 42 collegiate athletes randomly selected from several sports. All athletes were screened using a 14-point H and P based on 2014 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines, ECG, and cardiac ultrasound.

Results: We screened 11 female and 31 male athletes. On ultrasound, male athletes demonstrated significantly larger interventricular septal wall thickness (p = 0.002), posterior wall thickness (p <0.001) and aortic root breadth (p = 0.002) compared to females. Based on H and P and ECGs alone and a combination of H and P with ECG, no athletes demonstrated a positive screening for cardiac abnormalities. However, with combined H and P, ECG, and cardiac ultrasound, one athlete demonstrated positive findings.

Conclusions: We believe that adding point of care ultrasound to the preparticipation exam of college athletes is feasible. This workflow may provide a model for athletic departments' screening.


Sudden cardiac death is a rare but leading cause of death in young athletes on the playing field.[1] These deaths are usually due to unsuspected heart disease, as many conditions are not detected by routine screening measures.[2] National Collegiate Athletic Association (NCAA) athletes partake in rigorous training programs at an elite level. For collegiate athletes with a previously undiagnosed cardiac condition, the activity during training and competition places them at high risk for sudden cardiac death. The causes of sudden death in athletes under the age of 35 include hypertrophic cardiomyopathy (HCM), coronary artery anomalies, long QT syndrome, and infections such as myocarditis.

There are approximately 75 terminal outcomes per year in the United States in athletes between the ages of 13 and 25 years (89% occurring in males) with the majority immediately after exercise.[3–5] New findings from an Italian Registry show a reduction of sudden death in athletes over the past decade due to enhanced screening of athletes, aged 16 and older.[6] Pre-participation cardiovascular screening in athletes can uncover some of the underlying conditions contributing to this risk.[7,8] The American Heart Association (AHA) and American College of Cardiology (ACC) Guidelines support screening with a 14-point history and physical examination (Appendix 1).[9] However, studies have shown that the current screening techniques are insensitive in diagnosing many cardiac conditions.[7,8] Early screening of patients at risk may improve the identification and early prevention of these cardiovascular events.[10] Despite this data, there is still no universal and standardized applied screening method for incoming student athletes.[11]

A history and physical (H and P) examination without an electrocardiogram (ECG) are of questionable value and have not demonstrated cost-effectiveness due to their poor sensitivity and specificity.[12,13] Prior studies have determined that routine screening with ECG and physical exam alone can detect some abnormalities.[14–18] However, an issue posed by the AHA is the implication of medical liability in the current climate where no standardized means exist to clear student athletes for sport if they are deemed inappropriate to participate based on ECG findings.[11] Other studies indicate that by providing a more standardized means for ECG analysis will provide a more homogenous and consistent interpretation of ECG screenings.[19–20] In this study we aimed to assess the feasibility of conducting point of care cardiac ultrasounds in addition to routine preparticipation screening in collegiate athletes.