The Pre-Participation Examination in a COVID-19 World

Kristin Malek, DNP, APRN, CPNP-PC


Pediatr Nurs. 2021;47(6):299-300. 

In This Article

Assessing Cardiovascular Risk Factors

A leading cause of death while participating in sports in young athletes is sudden cardiac death (SCD) (Williams et al., 2019). This fact coupled with the risk of myocarditis and rapid-onset heart failure in patients diagnosed with COVID-19 can make parents uneasy when their child returns to sports. To thoroughly screen for cardiac disorders, in 2014, the American Heart Association (AHA) expanded its questionnaire to a 14-point evaluation. The parent is responsible for completing the history portion of the examination, while the provider will review the questionnaire and perform a physical examination, focusing on heart murmurs, femoral pulses, physical stigmata of Marfan syndrome, and brachial artery blood pressure. The provider is encouraged to consider an electrocardiography (ECG), echocardiography, and/or referral to a cardiologist for any abnormal cardiac history or examination findings (IHSA, 2021).

Prior to the COVID-19 pandemic, there has been a long-standing debate regarding if the 14-point cardiac evaluation was effective in detecting potential cardiac disorders. Debate has occurred around if an ECG should be routinely completed in addition to the history and physical examination (Williams et al., 2019). According to the American Academy of Pediatrics (AAP) (2021) guidelines, a 12-lead ECG should be considered in asymptomatic or mildly symptomatic athletes diagnosed with COVID-19. A 12-lead ECG should be performed in any athlete with moderate to severe COVID-19 symptoms. The provider should refer to cardiology with any abnormal ECG or severe COVID-19 symptoms (AAP, 2021). However, this continues to beg the question: Should pre-participation ECG's become standardized in a COVID-19 world?