A pilot study of clinical agreement in cardiovascular preparticipation examinations: how good is the standard of care?

Journal Article (Journal Article)

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 kappa 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.

Full Text

Duke Authors

Cited Authors

  • O'Connor, FG; Johnson, JD; Chapin, M; Oriscello, RG; Taylor, DC

Published Date

  • May 2005

Published In

Volume / Issue

  • 15 / 3

Start / End Page

  • 177 - 179

PubMed ID

  • 15867562

International Standard Serial Number (ISSN)

  • 1050-642X

Digital Object Identifier (DOI)

  • 10.1097/01.jsm.0000156150.09811.63f


  • eng

Conference Location

  • United States