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Doctors develop new exam form

By Jeffery Armstrong

Thanks to the determination of two doctors and one medical resident, the state of Georgia may drop down in the rankings of states with cases of sudden cardiac deaths among young athletes.

Jack Stevens, M.D. and David Marshall, M.D., both of Children's Healthcare of Atlanta, have developed a standard pre-participation physical evaluation form designed to capture more information that will highlight undiagnosed heart problems.

Despite all the attention that's given to heat-related problems among young and adult athletes, heart-related problems are just as big in this state. Already this year, Children's Healthcare received reports that five Georgia students have collapsed and died suddenly while playing sports.

"As recently as the mid-1990's, Georgia was ranked as high as third in the nation in sudden cardiac deaths among young athletes," said Marshall, director of Children's Sports Medicine Program. "Georgia was also one of eight states without a standard form for physicals."

Now the number of states without a standardized form should drop to seven. The doctors proposed their new form to Ralph Swearngin, Executive Director of the Georgia High School Association, in late January and to the GHSA's Executive Committee on March 31 and it was unanimously approved and strongly recommended for the state's high school athletic directors to use this school year. The new form will hopefully identify at-risk athletes and prevent any more sudden deaths.

Local pediatricians and family physicians will have a chance to hear how Stevens and Marshall will try to keep young athletes safe in Georgia at a presentation at the Eagle's Landing Country Club tonight at 6 p.m.

Marshall will talk about sports injuries that come from head injuries, overuse of steroid and steroid-like substances while Stevens, Director of Preventive Cardiology at Sibley Heart Center at Children's, will talk about heart-related injuries and how youth can avoid them.

Stevens said he got the impetus to establish a form two years ago when he saw the forms that students brought to him after they failed high school physicals.

"I saw the death reports of Georgia high school kids and when kids recently came to me for physicals, I noticed their high school forms didn't look good," said Stevens. "Those forms didn't ask any cardiac (heart-related) questions at all, especially the ones that were recommended by the American Heart Association."

Among those questions the AHA recommends are those dealing with heart murmurs, family history of heart disease and chest pains during or after exercise.

Stevens decided to do a study of Georgia high school physical evaluation forms and received help from Marshall and Emory resident Laurie Weiser. Weiser developed a statewide survey and asked all 389 state athletic directors to send them their forms. Nearly 80 percent of the AD's responded and the doctors were surprised at what they saw – there were 89 different forms used throughout the entire state.

"Several of these forms were not good at all. Many were basically blank sheets of paper with a doctor's signature on it," Marshall said.

Out of the all the returned forms, 24 percent asked no cardiac questions, about 70 percent asked two questions or less and only eight percent asked every question.

The new form asks all those questions and some questions dealing with asthma, seizures, severe headaches and supplements. Marshall said this form is good for the students because many of them aren't able to get to the doctor on a regular basis. He hopes that many of the schools will use this form, especially in rural Georgia.

"We've found out that 75 percent of young athletes view their sports physical as their yearly trip to the doctor," said Marshall. "It's amazing – we take better care of our cars than our own bodies."

Both doctors want this to be a form which will allow kids to keep playing sports, not discourage them from playing.

"I want to emphasize that we want all the kids to play the sports they love," said Stevens. "We want them to be active, drive safely and stay away from doing drugs, alcohol, tobacco and other dangerous items."

Stevens said youth, especially those athletes with a family history of heart trouble, need to talk to their family physicians and help themselves and their hearts through running, swimming and bicycling as much as possible. They should also watch their weight (shedding fat pounds, keeping muscle) and stick to a low-fat, high fiber diet, filling up on fruits and vegetables and staying away from dangerous supplements, like ephedra.

The new form can be viewed on the Children's Healthcare website, www.choa.org (click on the Sports Medicine link), and the GHSA website, www.ghsa.net (click on the Athletics link).