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