Evaluation of a Preparticipation Cardiovascular Screening Program Among 1,686 National Collegiate Athletic Association Division I Athletes: Comparison of the Seattle, Refined, and International Electrocardiogram Screening Criteria.

OBJECTIVES: To: (1) analyze the results of 5 years of preparticipation cardiac screening including 12-lead electrocardiogram (ECG) of National Collegiate Athletic Association (NCAA) Division I athletes; and (2) assess the rates of ECG screening abnormalities and false-positive rates among 3 ECG screening criteria. DESIGN: Retrospective chart review. SETTING: National Collegiate Athletic Association Division I University. PARTICIPANTS: One thousand six hundred eighty-six first-year athletes presenting for their preparticipation examination including 12-lead resting ECG. INTERVENTIONS: At the completion of the study period, all ECGs were retrospectively reviewed using the Seattle, Refined, and International Criteria. MAIN OUTCOME MEASURES: (1) Prevalence of pathologic cardiac conditions identified by screening; and (2) number of ECG screening abnormalities by criteria. RESULTS: Three athletes (0.2%) were found to have conditions that are associated with sudden cardiac death. Retrospective review of ECGs using Seattle, Refined, and International criteria revealed an abnormal ECG rate of 3.0%, 2.1%, and 1.8%, respectively. International criteria [odds ratios (OR), 0.58; P = 0.02] demonstrated a lower false-positive rate compared with the Seattle criteria. There was no significant difference in false-positive rates between the Seattle and Refined (OR, 0.68; P = 0.09) or the International and Refined criteria (OR, 0.85; P = 0.5). CONCLUSIONS: There was a low rate of significant cardiac pathology in this population, and no athletes were permanently restricted from play as a result of screening. Our results suggest that the International criteria have the lowest false-positive rate of athlete-specific ECG criteria, and thus, it is the preferred method for preparticipation ECG screening in NCAA athletes.

Time Out of Play Due to Illness in Major and Minor League Baseball.

OBJECTIVE: To generate a summative report on the most commonly diagnosed illnesses in Major League Baseball (MLB) and Minor League Baseball (MiLB) athletes with specific attention to their impact based on time out of play. DESIGN: Retrospective analysis. SETTING: Injury and illness data from the MLB Health and Injury Tracking System. PARTICIPANTS: All MLB and MiLB athletes active between 2011 and 2016. ASSESSMENT OF RISK FACTORS: Illnesses were defined as atraumatic medical diagnoses that occurred during the MLB or MiLB season and resulted in at least 1 day out of play. MAIN OUTCOME MEASURES: Incidence of illness diagnoses and resulting time out play. RESULTS: Eight thousand eight hundred thirty-four illnesses were reported, representing 14.7% of all diagnoses resulting in time out of play. Total days missed (DM) due to illness were 39 614, with a mean of 4.6 (SD 9.9 days) and median 2 DM per diagnosis. The annual incidence of illness per season was 20.3 per 100 athletes. The most common diagnosis was nonspecific viral illness (15.3%), followed by gastroenteritis (13.6%), other gastrointestinal illness (8.3%), influenza (7.0%), and upper respiratory infection (6.2%). Appendicitis (15.2%) and Epstein-Barr virus/cytomegalovirus (9.1%) were the most common season-ending diagnoses. CONCLUSIONS: Illnesses represent a significant cause of time out of play in MLB and MiLB. Prevention efforts should focus on limiting the spread of communicable viral, respiratory, and gastrointestinal disease among players, as the majority of diagnoses fell into these categories. This work may be used to guide future research into illness treatment and prevention in professional baseball.

Preparticipation Cardiovascular Screening: An Infrastructure Assessment in Collegiate Athletics.

OBJECTIVE: To assess the available infrastructure for secondary testing after preparticipation cardiovascular screening of collegiate athletes. DESIGN: Cross-sectional study. SETTING: National Collegiate Athletic Association (NCAA) athletic programs PARTICIPANTS:: Team physicians. INTERVENTIONS: Online survey distributed by the NCAA and American Medical Society for Sports Medicine. MAIN OUTCOME MEASURES: Availability of secondary cardiovascular diagnostic testing and services. RESULTS: Team physicians from 235 schools completed the assessment, representing 21% of all NCAA schools. Ninety (38.3%) NCAA team physicians reported screening athletes using electrocardiogram (ECG). Division I schools were more likely than Division II and III schools to perform both screening ECG (RR, 2.38, P < 0.0001) and echocardiogram (RR, 2.83, P = 0.01). More than 97% of schools had access to resting echocardiogram, stress ECG/echocardiogram, and Holter monitoring within 25 miles with no significant variability between divisions, regions, or size of undergraduate student body. Cardiac magnetic resonance imaging and electrophysiology studies were available within 25 miles of more than 80% of schools, and genetics testing was available within 25 miles for 64.8%. CONCLUSIONS: Secondary testing for cardiovascular abnormalities seems to be readily available for NCAA athletes, regardless of division, region, or school size.

Prevalence of Inadequate Immunity to Measles, Mumps, Rubella, and Varicella in MLB and NBA Athletes.

BACKGROUND: Multiple outbreaks of vaccine-preventable viral diseases have occurred in professional sports in recent years. Currently, there is no established protocol for vaccination or immunity screening for professional athletes. HYPOTHESIS: There are significant differences in the prevalence of inadequate immunity dependent on age, sport, country of birth, and participation in collegiate sports. STUDY DESIGN: Cross-sectional cohort study. LEVEL OF EVIDENCE: Level 4. METHODS: A sample of Major League Baseball (MLB) and National Basketball Association (NBA) players were screened for serologic evidence of immunity to measles, mumps, rubella, and varicella prior to the 2015 and 2016 seasons. The results were designated as adequate (immune) or inadequate (equivocal or nonimmune) based on laboratory criteria. Comparison with an age-matched control group was performed using data from the National Health and Nutrition Examination Survey (NHANES). RESULTS: A total of 98 athletes (62 MLB, 36 NBA) were screened. The prevalence of inadequate immunity for any virus was 35.5% in MLB players and 33.3% in NBA players. There was a significantly greater risk of inadequate immunity to rubella (risk ratio, 6.38; P < 0.01) and varicella (risk ratio, 4.21; P < 0.01) in athletes compared with the age-matched NHANES population. Our analysis did not reveal differences in rates of immunity based on sport, country of birth (US born vs international), or participation in college athletics. There was a lower rate of inadequate immunity to varicella with increasing age (odds ratio, 0.72; P = 0.05). CONCLUSION: One-third of athletes studied had inadequate immunity to 1 of the 4 viruses tested. Younger players had a significantly greater risk of inadequate immunity to varicella. Birth outside the US and lack of participation in college athletics were not found to influence immunity rates. CLINICAL RELEVANCE: These results can inform the development of future screening programs to prevent outbreaks of viral infections in professional athletes.

Using Clinical Decision Support Within the Electronic Health Record to Reduce Incorrect Prescribing for Acute Sinusitis.

PURPOSE: Acute sinusitis has viral etiology in more than 90% of cases, but antibiotics are prescribed for more than 80% of adults in the United States. While applications of computer-assisted guidelines have been found effective in reducing inaccurate prescribing for acute respiratory infections, there is a paucity of research focused specifically on the utilization of electronic best practice alerts (BPA) in improving treatment for acute sinusitis. METHODS: This observational cohort study examined prescribing behavior for sinusitis at a single Federally Qualified Health Center 1 year prior and during the first year of implementation of a BPA in the electronic health record (EHR) reminding providers of the recommended treatment of sinusitis. The advisory included a link to national guidelines and a note template was installed to assist providers in documentation. The BPA appeared on the providers' screen when an ICD-9 code of acute or bacterial sinusitis was entered during the patient visit. RESULTS: After adjusting for select patient and provider factors, the computer-assisted guidelines effectively reduced the overall antibiotic prescribing among these patients by 31% (relative risk: 0.69, 95% confidence interval: 0.51-0.95) and reduced incorrect prescribing from 88.5% to 78.7% (P=0.02). CONCLUSIONS: Clinical reminders within the EHR can be an effective tool to reduce inappropriate antibiotic use and improve providers' decisions regarding the correct antibiotic choices for patients with acute sinusitis.