{"id":11967,"date":"2026-09-07T06:00:55","date_gmt":"2026-09-07T05:00:55","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=11967"},"modified":"2026-09-03T19:38:45","modified_gmt":"2026-09-03T18:38:45","slug":"does-history-physical-examination-still-matter-if-the-athletes-ecg-is-normal","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2026\/09\/07\/does-history-physical-examination-still-matter-if-the-athletes-ecg-is-normal\/","title":{"rendered":"Does History & Physical Examination Still Matter if the Athlete\u2019s ECG is Normal?"},"content":{"rendered":"

Keywords:<\/b> Collegiate athletes, preparticipation evaluation, cardiovascular screening, electrocardiogram (ECG), sudden cardiac death<\/span><\/p>\n

Background<\/b><\/p>\n

Preparticipation cardiovascular screening of athletes has long been a core tenet of the sports medicine physician\u2019s role. While its importance is clear, the optimal approach remains debated\u2014this blog summarizes our <\/span>recent meta-analysis of NCAA athletes<\/span><\/a> and explores why our findings may prompt a rethinking of the current screening paradigm (1).<\/span><\/p>\n

Why is this study important?<\/b><\/p>\n

Preparticipation cardiovascular screening is a cornerstone of athlete care, aimed at identifying conditions associated with sudden cardiac arrest and death (SCA\/D). This is critical given sudden cardiac arrest is the most common cause of exercise-associated fatality in athletes (2). Historically, the history and physical exam (H&P) have been the foundation of the pre-participation screening process, largely due to its accessibility and low cost. However, research has repeatedly shown that H&P performs poorly in identifying conditions associated with SCA\/D, particularly when compared to electrocardiogram (ECG) screening using athlete-specific interpretation criteria (3, 4). Despite this research there is a lack of consensus on the optimal preparticipation screening strategy for cardiovascular conditions predisposing athletes to SCA\/D.\u00a0<\/span><\/p>\n

To address this gap, our study comprehensively evaluated all studies existing in the literature that examined the outcomes of preparticipation cardiovascular screening of NCAA athletes. We also used a novel analysis to address the following important question: <\/span>What additional value does the H&P provide when an ECG is already normal?<\/span><\/i><\/p>\n

This question is highly relevant for clinicians balancing early detection, false positives, and downstream testing\u2014all within time-pressured clinical environments.<\/span><\/p>\n

How did the study go about this?<\/b><\/p>\n

We performed a systematic review and meta-analysis of 27,891 NCAA athletes, comparing the diagnostic performance of ECG screening versus H&P alone for detecting cardiovascular conditions associated with SCA\/D.<\/span><\/p>\n

We specifically evaluated:<\/span><\/p>\n