A pilot study of clinical agreement in cardiovascular preparticipation examinations: how good is the standard of care?
| Autor: | Jeremy D Johnson, Dean C. Taylor, Ralph G. Oriscello, Francis G. O'Connor, Mark Chapin |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male medicine.medical_specialty genetic structures Referral Sports medicine Adolescent Health Planning Guidelines Physical Therapy Sports Therapy and Rehabilitation Physical examination Pilot Projects Risk Assessment Cohen's kappa Informed consent medicine Outpatient clinic Humans Mass Screening Orthopedics and Sports Medicine Physical Examination Mass screening School Health Services Observer Variation Health Services Needs and Demand medicine.diagnostic_test Heart Murmurs business.industry Incidence Echocardiography Doppler Cross-Sectional Studies Cardiovascular Diseases Athletic Injuries Cadet Physical therapy Female business Sports Total Quality Management |
| Zdroj: | Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine. 15(3) |
| ISSN: | 1050-642X |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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