Research Literature, Design, Sampling, and Implementation

Research Literature Support

The PICOT for this EBP proposal is as follows: P: Patients from age 12 to age 18 seeking physical exam for sports medical clearance, I: 12 lead EKG acquisition and interpretation, C: Sports history physical examination and medical clearance for participation without 12 lead EKG acquisition, O: Identify risk factors for sudden cardiac death in adolescent athletes, and T: one year.

The data between different research studies continues to spark debate on the need for using electrocardiograms (ECG) during the prescreening process.  A detailed literature review of previous research studies focused on the incidence of sudden cardiac death (SCD) and the associated identifiable risk factors was conducted. The purpose of the Sports-related sudden cardiac death in the young population of Switzerland research study was to compare trends in sports-related sudden cardiac deaths with those unrelated to exercise (Asatryan et al., 2017).

A quantitative research approach was used to retrospectively analyze autopsy reports in Switzerland for unexpected sudden deaths from 1999 to 2010 in individuals aged 10 to 39 years of age (Asatryan et al., 2017).  Asatryan et al. (2017) defined SCD as death occurring within twenty-four hours of onset of physical activity and probable cause of death as fatal arrhythmia or cardiac pathology identified by post-mortem exam. The researchers then broke this data into three categories: no sports, recreational sports, or competitive sports, based on activity level at time of death (Asatryan et al., 2017).

The forensic autopsy reports in Switzerland contain extensive information to include the post-mortem exam results and detailed circumstances of death that are obtained from witness and family members. Data collection also included obtaining information related to sports participation by conducting surveys via telephone and online. The data was then broken down in the three previous established categories for none, recreational, or competitive (Asatryan et al., 2017).

Asatryan et al. (2017) analyzed 349 deaths to acquire the results of this particular research study.  Of these deaths, 52 deaths were among individuals who participated in sports, either recreational or competitive (Asatryan et al., 2017). Analyzation of the causes of death revealed that coronary artery disease (CAD) was the most common cause of SCD within this study.  More than fifty percent of all sudden cardiac deaths attributed to CAD in all three categories occurred in the absence of an acute myocardial infarction (MI) and overall, this study revealed a low incidence of SCD related to cardiomyopathies (Asatryan et al., 2017).

Asatryan et al. (2017) noted that a strength of this study was the evidence that substantiated the idea of regional differences in underlying causes of SCD.  One limitation of this study is the possibility that data collection coincided with the implementation of ECG based pre-participation screenings, thus individuals with ECG detectable cardiomyopathies may have been excluded from the study (Asatryan et al., 2017).

Maron, Haas, Murphy, Ahluwalia, and Rutten-Ramos (2014) utilized a quantitative design to conduct a retrospective nonexperimental research study with the objective of the study to accurately defining the incidence and causes of SCD in college student-athletes. In this research study, Maron et al. (2014), reviewed deaths and postmortem findings of athletes from 2002 to 2011. The researchers utilized the U.S. National Registry of Sudden Death in Athletes database, established in 1992 by the Minneapolis Heart Institute Foundation, to assemble data in a systematic manner on athletes participating in organized sports in a systematic manner. Maron et al. (2014) established systematic tracking to obtain detailed case information and additionally conducted family, witness, and coach interviews to collect demographics, circumstances of death, and additional pertinent clinical data. Allina Health System Institutional Review Board approved this project, and researchers protected subject anonymity and confidentiality (Maron et al., 2014).

Participation in an organized sport that requires regular training and completion was the inclusion criterion for the study. Death attributed to a club or intermural sports, motor vehicle accidents, suicide, homicide, cancer or other systemic disease were considered exclusion criteria and this data was not utilized. Over a period of nine years, there was a total of 182 sudden deaths; however, 118 were identified as other causes than cardiovascular disease.  The results of this study conclude that of 47 diagnoses of cardiovascular disease found on autopsy, 28 would have likely been identified using the pre-screening ECG (Maron et al., 2014).

One limitation of this study is that the data did not focus on identifying the most effective pre-screening strategy for detection of cardiovascular risks in young athletes, which remains a controversy (Maron et al., 2014). Maron et al. (2014) did have results that did, however, identify the frequency of false-negative pre-screening results, regardless of screening limited to history and physical