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Related Experiment Video

Updated: Aug 17, 2025

Autonomic Function Following Concussion in Youth Athletes: An Exploration of Heart Rate Variability Using 24-hour Recording Methodology
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Preparticipation State Cardiac Screening Forms for Athletes.

Zane J Blank1, Robert L Spicer2,3, Jeffrey A Robinson2,3

  • 1Department of Internal Medicine, University of Washington-Boise, Boise, Idaho.

Pediatrics
|December 15, 2022
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Summary

Most US states do not fully implement the American Heart Association's 14 cardiac screening elements in preparticipation physical evaluations (PPE) for high school athletes. This gap highlights potential risks for sudden cardiac death in young athletes.

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Area of Science:

  • Cardiology
  • Sports Medicine
  • Public Health

Background:

  • Annual preparticipation physical evaluations (PPE) are crucial for screening adolescents for sudden cardiac death.
  • The American Heart Association (AHA) outlines 14 essential screening elements for PPE.
  • This study assesses the adoption of these AHA recommendations by US states for high school athletics.

Purpose of the Study:

  • To determine the extent to which US states incorporate the AHA's 14 recommended cardiac screening elements into their official PPE forms.
  • To identify specific screening elements that are frequently omitted in state-mandated PPE protocols.

Main Methods:

  • Collected official PPE forms from the governing bodies of high school athletics in all 50 US states via public websites.
  • Analyzed the content of collected PPE forms to identify the presence or absence of each of the 14 AHA screening elements.
  • Excluded forms from private/parochial schools or other organizations not representing state-level mandates.

Main Results:

  • PPE forms were available online in 48 states (96%); 2 states deferred documentation to local districts.
  • Only 13 states (27%) included all 14 AHA recommended screening elements.
  • Commonly omitted elements included femoral pulse examination (58%), family history of inherited cardiac disease (31%), and personal history of hypertension (27%).

Conclusions:

  • A minority of US states fully implement the comprehensive cardiac screening guidelines recommended by the AHA for adolescent athletes.
  • Significant variations exist in the utilization of critical screening elements, potentially impacting early detection of cardiac conditions.
  • Standardization of PPE protocols to include all recommended elements is needed to enhance athlete safety.