Online health form
efficiently screens Stanford athletes
BY MIKE GOODKIND
A personal health history,
filled out online by prospective student athletes, can
help physicians screen for the risk of sudden cardiac
death and other health threats, the director of
Stanford's sports medicine program suggests in the June
10 Journal of the American Medical Association.
"When you have 500
athletes in one place on a Sunday waiting to be examined
by 15 volunteer physicians, you must develop an effective
system that will detect the rare student who might be at
risk of injury or sudden death, while not being so
sensitive that it eliminates a healthy player from
competition unnecessarily," observed Dr. Gordon
Matheson, professor of functional restoration and chief
of the Division of Sports Medicine, in an editorial
accompanying a JAMA research.
"And even in a
private sports exam not to mention the larger
screening exams we have found that we must continue to
develop a form which will help physicians cut efficiently
through a maze of information to pinpoint areas of
concern. Also, since many of the student athletes will
have no other physical exams during their high school
career, it's reasonable to include general screening to
assess the student's overall health," Matheson said.
In his editorial he
described the 22-page health questionnaire completed by
each of Stanford's more than 800 intercollegiate
athletes. The questionnaire, posted online
(www.stanford.edu/dept/ sportsmed), takes about 30
minutes to fill out. The system then securely filters the
student's answers and prepares a one- or two-page summary
highlighting specific points physicians need to pursue
with the prospective athlete.
This pre-participation
form is being refined and should be available for use
elsewhere in the nation in about a year, Matheson said.
The form was developed
about a year ago by Dr. Julie Peltz, a clinical fellow in
sports medicine and postdoctoral fellow at the Stanford
Center for Research in Disease Prevention. Peltz
emphasized that a key goal in developing the form
"was not just to screen for participation risks such
as sudden cardiac death but to provide a more
comprehensive health assessment for adolescents."
The online form is
preferable to adding extra questions to the standard
health form that in most parts of the country is filled
out by students and completed by physicians, Matheson
said.
His editorial was written
in response to an accompanying article by Dr. David W.
Glover of the ambulatory care division at St. Luke's
Hospital in Kansas City, Mo., and Dr. Barry J. Maron of
the Minneapolis Heart Institute Foundation. Glover and
Maron found that screening programs to help detect a risk
of sudden cardiac death in high school athletes vary from
state to state and appear to be inadequate in many cases.
The authors note that many states, including California,
don't specify questions that should be asked during
pre-season physicals, leaving open the possibility that
extremely rare but potentially lethal conditions will go
undetected in such screenings.
"The large number of
negative responses to questions and normal physical
examinations during mass screening examinations serves to
dull the acumen of even the most careful of
physicians," Matheson wrote. Consequently, he said
in an interview, simpler systems such as the interactive
computer form are preferable to increasing the level of
detail on existing forms filled out by physicians and
athletes.
The online forms take less
time to complete, and the two-page summaries help
physicians focus "immediately on key questions and
get right to the point," Matheson said.
Sudden cardiac death is
rare, he said, affecting only one in 200,000 student
athletes. Signs to watch for include chest pains,
lightheadedness and a family history of heart disease at
an early age, Matheson said. Marfan syndrome, an
inherited disorder carrying the risk of sudden cardiac
death, often can be flagged through questions about
family history and by asking about a characteristic
cluster of warning signs that may appear in the young
athlete.
Good pre-participation
questionnaires are also designed to flag previous
surgeries or medical conditions that could lead to
injuries, such as a cervical spine instability that
places athletes in contact sports at risk for
quadriplegia, Matheson said.
He concedes that there are
obstacles to implementing an online health form. In many
parts of the country, students and even some physicians
may not have ready access to computers. "But they
will soon, and in any case we need to work toward this as
the approach of the future," Matheson said.
In the meantime, team
physicians or the forms they use should ask a set of 13
questions deemed essential by the American Heart
Association for detecting cardiac abnormalities, as well
as a few questions to uncover signs of Marfan syndrome,
he said.
Glover and Maron noted
that only 43 states and the District of Columbia have
formal screening requirements. Of the 51 jurisdictions
surveyed, only 17 uses history and physical
questionnaires with at least nine of the 13 American
Heart Association recommendations. Eight states,
including California, have no standards for physicals,
and one state, Rhode Island, doesn't even require
physical exams for its high school athletes. SR
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