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  • COLLEGIATE ATHLETES’ KNOWLEDGE OF SUDDEN CARDIAC DEATH ON

    SIGNS & SYMPTOMS AND RISK FACTORS

    A THESIS

    Submitted to the Faculty of the School of Graduate Studies

    and Research

    of

    California University of Pennsylvania in partial

    fulfillment of the requirements for the degree of

    Master of Science

    by

    Brittney Brown, ATC, PES

    Research Advisor, Dr. Carol Biddington

    California, Pennsylvania

    2013

  • ii

    CALIFORNIA UNIVERSITY of PENNSYLVANIA

    CALIFORNIA, PA

    THESIS APPROVAL

    Graduate Athletic Training Education

    We hereby approve the Thesis of

    Brittney Brown

    Candidate for the degree of Master of Science

    Date Faculty

  • iii

    ACKNOWLEDGEMENTS

    Firstly, I would like to thank my family. I went back

    to school for them, to be everything they ever thought I

    could be. To my parents, thank you for sticking by me

    while I moved back and forth from home. Mom, I want to

    thank you for doing my laundry whenever I came home and

    putting up with my late night studying habits. Dad, I

    would like thank you for taking me fishing and out to eat

    to help relieve some stress from my classes. Ryan, thank

    you for dealing with me as another mom while I was home.

    To Poppy and Nanny, I am so grateful you were able to see

    me graduate from grad school and start my life. You have

    pushed me from day one and I appreciate every bit. I love

    you all and thank you.

    To my thesis advisor, Dr. Carol Biddington, I want to

    thank you for putting up with my procrastination and

    keeping me on track. Your wisdom and knowledge is a main

    reason I was able to understand this process and finish it.

    I also would like to thank Dr. Michael Meyer and Dr. Ayanna

    Lyles for being on my thesis committee and steering me in

    the right direction.

    I would also like to thank Westminster College for

    agreeing to send my survey out to their student athletes.

    Also, thank you to the athletic director Mr. James Dafler.

    You were very compliant and helpful in achieving success

    with my survey. I would like to thank the athletes who

    participated in the survey. Without you, I would not have

    completed this thesis.

  • iv

    TABLE OF CONTENTS

    Page

    SIGNATURE PAGE . . . . . . . . . . . . . . . ii

    AKNOWLEDGEMENTS . . . . . . . . . . . . . . . iii

    TABLE OF CONTENTS . . . . . . . . . . . . . . iv

    LIST OF TABLES . . . . . . . . . . . . . . . vii

    INTRODUCTION . . . . . . . . . . . . . . . . 1

    METHODS . . . . . . . . . . . . . . . . . . 6

    Research Design . . . . . . . . . . . . . . 6

    Preliminary Research . . . . . . . . . . . . 7

    Subjects . . . . . . . . . . . . . . . . . 7

    Instruments . . . . . . . . . . . . . . . . 8

    Procedures. . . . . . . . . . . . . . . . . 9

    Hypotheses. . . . . . . . . . . . . . . . . 10

    Data Analysis . . . . . . . . . . . . . . . 10

    RESULTS . . . . . . . . . . . . . . . . . . 11

    Demographic Data . . . . . . . . . . . . . . 11

    Hypothesis Testing . . . . . . . . . . . . . 13

    Additional Findings . . . . . . . . . . . . . 14

    DISCUSSION . . . . . . . . . . . . . . . . . 17

    Discussion of Results . . . . . . . . . . . . 17

    Conclusion . . . . . . . . . . . . . . . . 20

    Recommendations. . . . . . . . . . . . . . . 21

  • v

    REFERENCES . . . . . . . . . . . . . . . . . 25

    APPENDICES . . . . . . . . . . . . . . . . . 29

    APPENDIX A: Review of Literature . . . . . . . . 30

    Prevention of Sudden Cardiac Death. . . . . . . 31

    Screening . . . . . . . . . . . . . . . . 31

    History . . . . . . . . . . . . . . . . . 37

    Background of Sudden Cardiac Death in Sport . 39

    Incidence . . . . . . . . . . . . . . . . 39

    Pathophysiology. . . . . . . . . . . . . 43

    Collegiate Athletes Knowledge of Healthcare . 45

    Summary. . . . . . . . . . . . . . . . . . 49

    APPENDIX B: The Problem . . . . . . . . . . . . 52

    Statement of the Problem . . . . . . . . . . . 53

    Definition of Terms . . . . . . . . . . . . . 53

    Basic Assumptions . . . . . . . . . . . . . . 54

    Limitations of the Study . . . . . . . . . . . 54

    Significance of the Study . . . . . . . . . . 55

    APPENDIX C: Additional Methods . . . . . . . . . 57

    Letter to the Experts (C1) . . . . . . . . . . 58

    Collegiate Athletes’ Knowledge on Sudden Cardiac

    Death Survey (C2) . . . . . . . . . . . . . 60

    IRB: California University of Pennsylvania (C3) . . 63

    Survey Cover Letter (C4) . . . . . . . . . . . 70

    REFERENCES . . . . . . . . . . . . . . . . . 72

  • vi

    ABSTRACT . . . . . . . . . . . . . . . . . . 76

  • vii

    LIST OF TABLES

    Table Page

    1. Gender of Athlete . . . . . . . . . . . . . . 11

    2. Age of Athlete . . . . . . . . . . . . . . 11

    3. Ethnicity of Athlete . . . . . . . . . . . . 11

    4. Sports Participated . . . . . . . . . . . . . 12

    5. CPR/AED Certified . . . . . . . . . . . . . . 12

    6. Formal Education on Sudden Cardiac Arrest/Death . . 12

    7. A MANOVA for Gender and Ethnicity on Cardiac Signs

    and Symptoms and Risk Factors . . . . . . . . . 14

    8. Sign and Symptoms Knowledge Answers . . . . . . 15

    9. Risk Factors Knowledge Answers . . . . . . . . 16

  • 1

    INTRODUCTION

    Many topics are currently being discussed regarding

    health care, but one topic that has become more and more

    reoccurring is sudden cardiac death. Sudden cardiac death

    is talked about happening from younger athletes all the way

    up to professionals. Even though the actual chance of

    sudden cardiac death in athletes is small, the fact that

    any athlete can die while playing the sport they love is

    horrifying. Research has been done on cardiac related

    issues, but screenings for athletes based on medical

    history are costly and time consuming. 1-10

    The prevention of sudden cardiac death is being

    investigated by medical professionals. One way that has

    been found to help limit the chance of death is from health

    history and screening. Obtaining a person’s medical

    history is part of a pre-participation exam done when an

    athlete enters college. The history form will identify

    previous health problems of the patient, including alarming

    conditions, which require special attention. 11-13

    The items

    found that needs special attention would then lead to a

    screening. Screening could be done for any type of problem

    including orthopedic along with cardiovascular. Due to the

    cost of different screenings through insurance companies,

  • 2

    some programs cannot refer patients who have these possible

    life threatening conditions. The worse part about

    screenings is that as much as they may save a life, the

    need for mandatory screenings with all athletes are not

    being done, some due to a lack of resources. Usually, only

    athletes who are deemed high risk are screened for

    different problems. 1-10

    One way knowledge will be increased in athletes is by

    educating the athletes on the background of sudden cardiac

    death in sport. The first thing that needs to be

    understood is incidence rate, which deals with

    geographical, sex, and age factors. Incidences of sudden

    cardiac death sometimes depend on where the athlete is

    participating. Elevation height along with the weather

    conditions could possibly lead to a higher risk of

    developing a heart condition. Risk of sudden cardiac death

    also depends on the age and sex of the athlete. 13-19

    Pathophysiologically, some ethnicities are more prone to

    developing heart conditions, which would lead to an

    increase of incidences that could potentially be deadly.

    Since certain races are prevalent in certain sports, which

    leads to a higher number of incidences for certain sports,

    than recorded in other sports. 20-22

  • 3

    Knowing the signs and symptoms of sudden cardiac death

    is helpful information when dealing with athletes. Studies

    have been done combining pre-participation screenings with

    ECG screenings. These studies have found that by

    screening, athletes with any cardiovascular disease not

    currently showing any signs or symptoms were able to be

    identified. Most states in the United States require some

    sort of pre-participation exams, even though ECG screenings

    are not done unless signs and symptoms are found in the

    participant. Information on sudden cardiac death helps

    identify signs and symptoms, which allows for the need of

    medical intervention when symptoms occur. 1-13

    A