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. doi: 10.1097/01.jsm.0000156150.09811.63f.


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.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Athletic Injuries / prevention & control
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / epidemiology
  • Cross-Sectional Studies
  • Echocardiography, Doppler / standards
  • Echocardiography, Doppler / trends
  • Female
  • Health Planning Guidelines
  • Health Services Needs and Demand
  • Heart Murmurs / diagnosis*
  • Heart Murmurs / epidemiology
  • Humans
  • Incidence
  • Male
  • Mass Screening / standards*
  • Mass Screening / trends
  • Observer Variation
  • Physical Examination / standards
  • Physical Examination / trends
  • Pilot Projects
  • Risk Assessment
  • School Health Services / standards*
  • School Health Services / trends
  • Sports*
  • Total Quality Management