title: Sudden cardiac death screening in adolescent athletes: an evaluation of compliance with national guidelines.
abstract: OBJECTIVE
  In the USA, the preparticipation physical evaluation (PPE) is the standard of care for screening eight million high-school athletes for their risk of sudden cardiac death (SCD). Our aim was to evaluate both physician and school compliance with national guidelines for SCD screening.
  
  
  METHODS
  We conducted a confidential survey of the Washington Chapter of the American Academy of Pediatrics (AAP), the Washington Academy of Family Physicians (WAFP) and Washington State high-school athletic directors. Responses were evaluated for compliance with the American Heart Association (AHA) guidelines for SCD screening.
  
  
  RESULTS
  We received a response rate of 72% (559/776) from the AAP, 56% (554/990) from the WAFP and 78% (317/409) from the athletic directors. Only 6% of all providers and 0% of schools were in compliance with AHA guidelines. In addition, 47% of the physicians and 6% of athletic directors reported awareness of the guidelines. There was no difference in compliance between physician specialties (p=0.20). Physician location, years of experience and exposure to SCD were not significantly associated with compliance. Provider knowledge of the guidelines, number of PPE/month and frequency of referrals to cardiology were all positively associated with improved overall compliance (p<0.05).
  
  
  CONCLUSIONS
  Despite the unaltered presence of the AHA SCD screening guidelines for the past 15 years, compliance with the recommendations is poor. Lack of compliance does not reflect clinical experience, but rather lack of knowledge of the guidelines themselves. New directions for provider education and policy requirements are needed to improve this implementation gap.
authors.affiliation: Department of Pediatrics (Division of Pediatric Cardiology), University of Cincinnati, Cincinnati, Ohio 45229, USA. nicolas.madsen@cchmc.org
authors.forename: Nicolas L
authors.initials: NL
authors.lastname: Madsen
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Drezner
authors.forename: Jack C
authors.initials: JC
authors.lastname: Salerno
mesh_terms: D000293:Adolescent; D002983:Clinical Competence / Q000592:standards; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D042241:Early Diagnosis; D005194:Family Practice / Q000592:standards; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D010372:Pediatrics / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D012572:School Health Services / Q000592:standards; D013177:Sports / Q000502:physiology*; D013178:Sports Medicine / Q000592:standards; D014861:Washington