A Pilot Study of Clinical Agreement in Cardiovascular Preparticipation Examinations: How Good is the Standard of Care?

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Objective:To evaluate the interobserver agreement between physicians regarding a abnormal cardiovascular assessment on athletic preparticipation examinations.Design:Cross-sectional clinical survey.Setting:Outpatient Clinic, United States Military Academy, West Point, NY.Participants:We randomly selected 101 out of 539 cadet-athletes presenting for a preparticipation examination. Two primary care sports medicine fellows and a cardiologist examined the cadets.Interventions:After obtaining informed consent from all participants, all 3 physicians separately evaluated all 101 cadets. The physicians recorded their clinical findings and whether they thought further cardiovascular evaluation (echocardiography) was indicated.Main Outcome Measures:Rate of referral for further cardiovascular evaluation, clinical agreement between sports medicine fellows, and clinical agreement between sports medicine fellows and the cardiologist.Results:Each fellow referred 6 of the 101 evaluated cadets (5.9%). The cardiologist referred none. Although each fellow referred 6 cadets, only 1 cadet was referred by both. The κ statistic for clinical agreement between fellows is 0.114 (95% CI, −0.182 to 0.411). There was no clinical agreement between the fellows and the cardiologist.Conclusions:This pilot study reveals a low level of agreement between physicians regarding which athletes with an abnormal examination deserved further testing. It challenges the standard of care and questions whether there is a need for improved technologies or improved training in cardiovascular clinical assessment.

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