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

Publication ,  Journal Article
O'Connor, FG; Johnson, JD; Chapin, M; Oriscello, RG; Taylor, DC
Published in: Clin J Sport Med
May 2005

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.

Duke Scholars

Published In

Clin J Sport Med

DOI

ISSN

1050-642X

Publication Date

May 2005

Volume

15

Issue

3

Start / End Page

177 / 179

Location

United States

Related Subject Headings

  • Total Quality Management
  • Sports
  • Sport Sciences
  • School Health Services
  • Risk Assessment
  • Pilot Projects
  • Physical Examination
  • Observer Variation
  • Mass Screening
  • Male
 

Citation

APA
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ICMJE
MLA
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O’Connor, F. G., Johnson, J. D., Chapin, M., Oriscello, R. G., & Taylor, D. C. (2005). A pilot study of clinical agreement in cardiovascular preparticipation examinations: how good is the standard of care? Clin J Sport Med, 15(3), 177–179. https://doi.org/10.1097/01.jsm.0000156150.09811.63f
O’Connor, Francis G., Jeremy D. Johnson, Mark Chapin, Ralph G. Oriscello, and Dean C. Taylor. “A pilot study of clinical agreement in cardiovascular preparticipation examinations: how good is the standard of care?Clin J Sport Med 15, no. 3 (May 2005): 177–79. https://doi.org/10.1097/01.jsm.0000156150.09811.63f.
O’Connor FG, Johnson JD, Chapin M, Oriscello RG, Taylor DC. A pilot study of clinical agreement in cardiovascular preparticipation examinations: how good is the standard of care? Clin J Sport Med. 2005 May;15(3):177–9.
O’Connor, Francis G., et al. “A pilot study of clinical agreement in cardiovascular preparticipation examinations: how good is the standard of care?Clin J Sport Med, vol. 15, no. 3, May 2005, pp. 177–79. Pubmed, doi:10.1097/01.jsm.0000156150.09811.63f.
O’Connor FG, Johnson JD, Chapin M, Oriscello RG, Taylor DC. A pilot study of clinical agreement in cardiovascular preparticipation examinations: how good is the standard of care? Clin J Sport Med. 2005 May;15(3):177–179.

Published In

Clin J Sport Med

DOI

ISSN

1050-642X

Publication Date

May 2005

Volume

15

Issue

3

Start / End Page

177 / 179

Location

United States

Related Subject Headings

  • Total Quality Management
  • Sports
  • Sport Sciences
  • School Health Services
  • Risk Assessment
  • Pilot Projects
  • Physical Examination
  • Observer Variation
  • Mass Screening
  • Male