Variation in Preparticipation Screening Medical Questionnaires and Physical Examinations Across Canadian Universities

Pre-participation screening of athletes to prevent sudden cardiac arrest or death is endorsed by international guidelines. Standardized histories and physical examinations are recommended to optimize effectiveness. To assess current screening practices across Canada in the university athlete population, we sought to analyze the preparticipation screening form of all universities. A comparative analysis to recommendations from the American Heart Association (AHA), European Society of Cardiology (ESC), and the Preparticipation Physical Evaluation (PPE-4) was conducted. Pre-participation forms from 30 of 56 U Sports universities were obtained. Adherence to published guidelines was highly variable. Ten percent strictly followed any of the 3 guideline recommendations, and only 43% contained at least 75% of the recommended items. Average percentage adherence to AHA and ESC guidelines was statistically significantly higher than adherence to the PPE-4 (62.2% and 66.1%, respectively, vs 52.7%, P < 0.001). Family history of common cardiac conditions predisposing athletes to sudden cardiac death and family history of sudden or unexpected death was omitted in 80% and 30% of forms, respectively. Recommendations for examining for stigmata of Marfan syndrome and assessment of femoral pulses was absent on more than 70% of forms. Although there is great controversy regarding the benefits and impact of screening, our results suggest that Canadian universities are conducting pre-participation screening although in a highly variable manner. Incomplete and variable screening questionnaires employed by Canadian universities may negatively affect the potential to identify athletes with underlying disease. We recommend that, if pre-participation screening is performed, a guideline-based questionnaire be used to optimize accuracy.