The clinical screen,
cited end to end.
Every SportSlip clearance applies the screening framework jointly endorsed by the American Academy of Pediatrics, American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and the American Orthopaedic Society for Sports Medicine[2]. Parents who want what European sports medicine has done since 1982 can add ECG cardiac rhythm screening per the European Society of Cardiology guidelines[3,5,13].
Four parts. Each one cited.
Each part of the screen below maps to a specific published protocol. We don\'t invent screening. We apply the protocols pediatric and sports medicine literature has already settled on, and add the European cardiac layer for parents who want it.
Cardiac history — AHA 14-element[1,6,14]
The American Heart Association's 14-element personal-and-family-history protocol — chest pain on exertion, exercise-related syncope, family history of sudden death under 50, known cardiac conditions, and so on. Designed to surface the cardiomyopathies, channelopathies, and structural anomalies that account for the overwhelming majority of sudden cardiac arrest in athletes under 25.
Musculoskeletal + neurologic — AAP PPE-5[2,12]
The American Academy of Pediatrics' standardized preparticipation evaluation, 5th edition. Joints, mobility, prior injuries, concussion history, return-to-play status. The guided video step walks parent and child through the PPE-5 musculoskeletal sequence — the same Apley scratch, duck-walk, and gait observations a pediatrician runs in person.
Mental health + risk behaviors[4,11,17]
Eating patterns, mood, sleep, substance use. For female athletes: energy availability, menstrual history, and bone-health risk per the Female Athlete Triad / Relative Energy Deficiency in Sport (RED-S) framework. The AMSSM, IOC, and Female Athlete Triad Coalition consensus statements all endorse this screen as part of routine preparticipation evaluation. Most paper sports physicals skip it.
Optional ECG cardiac rhythm screen[3,5,9,10,13]
Italy has required ECG screening for competitive athletes since 1982. The European Society of Cardiology, ESC EAPC, and Seattle/International ECG-interpretation criteria all endorse ECG-inclusive preparticipation screening. Corrado et al.'s 25-year Italian cohort (1979–2004, n=42,386 athletes) documented an 89% reduction in cardiovascular mortality among screened athletes vs. the unscreened general population.
The AAP recommends every child be asked these four questions at every well-child visit starting at age 6[20].
We ask them on every SportSlip intake. They\'re short, specific, and lifted directly from the published AAP / Section on Cardiology guideline[20].
- 1
Have you ever fainted, passed out, or had an unexplained seizure suddenly and without warning — especially during exercise or in response to sudden loud noises (doorbells, alarm clocks, ringing telephones)?
- 2
Have you ever had exercise-related chest pain or shortness of breath?
- 3
Has anyone in your family died suddenly and unexpectedly before age 50?
- 4
Has anyone in your family been diagnosed with hypertrophic or dilated cardiomyopathy, long QT syndrome, other ion channelopathies, Marfan syndrome, or clinically significant arrhythmias?
“A 12-lead electrocardiogram (ECG) identifies disorders associated with sudden death from cardiac causes in about two thirds of cases, including cases of hypertrophic cardiomyopathy, other cardiomyopathies, and electrical disorders such as the Wolff-Parkinson-White syndrome and long QT syndrome; this approach outperforms history taking and physical examination alone, with a low incidence of false-positive results when contemporary standards for ECG interpretation in athletes are followed.”
The numbers your pediatrician already knows.
Direct from the bodies that publish them.
“The 14-element AHA recommendations represent a reasonable and acceptable strategy for screening large populations of competitive athletes in the United States.”
“Preparticipation cardiovascular evaluation including personal and family history, physical examination, and 12-lead ECG is recommended for competitive athletes.”
“The combination of history, physical examination, and 12-lead ECG significantly improves the sensitivity of preparticipation cardiac screening over history and physical alone.”
“Implementation of a nationwide systematic preparticipation screening program with electrocardiogram was associated with a marked reduction in mortality from sudden cardiovascular death in young competitive athletes.”
The specific conditions that cause athletic SCD.
Sudden cardiac arrest in athletes under 35 is almost always attributable to a discrete, named diagnosis. The list below is what the literature consistently identifies as the highest-yield targets for preparticipation screening[1,6,14].
Hypertrophic cardiomyopathy (HCM)[8]
Autosomal-dominant disorder of the cardiac sarcomere. Single most common cause of athletic SCD in the US per the Maron registry.
Arrhythmogenic right-ventricular cardiomyopathy (ARVC)[3]
Fibro-fatty replacement of right-ventricular myocardium. Disproportionately represented in athletic SCD in Italian cohorts.
Long QT syndrome (LQTS)[1]
Congenital channelopathy causing prolonged ventricular repolarization. Often manifests with exertional or stress-induced syncope.
Wolff-Parkinson-White (WPW)[9]
Accessory atrioventricular conduction pathway. Detectable on resting ECG by characteristic delta wave.
Anomalous origin of a coronary artery[6]
Congenital coronary anatomy that becomes hemodynamically significant during exertion. The second-most-common cause of athletic SCD in some US series.
Marfan syndrome / thoracic aortic disease[1]
Connective-tissue disorder predisposing to aortic root dilation and dissection. Screened on history, family history, and stature/morphology.
Three outcomes. One protocol.
No flags
Signed clearance issued. Valid 12 months across every camp, league, and school form your kid hands you in that window.
One or more flags
Dr. Kawalek personally reviews the entire screen before clearing. May request additional documentation (recent records, medication list, prior cardiology workup) before issuing.
In-person needed
Anything that warrants a real cardiology or orthopedic workup — we don't issue clearance. We provide a referral letter explaining what to ask the specialist, and refund the visit.
Sudden cardiac arrest in young athletes is uncommon but devastating, with US high-school incidence estimated at roughly 1 per 80,000 athlete-years[7]. The Maron registry has catalogued 1,866 sudden deaths in young US competitive athletes over a 26-year window, most occurring during or just after exertion[6]. The conditions responsible — hypertrophic cardiomyopathy, arrhythmogenic right-ventricular cardiomyopathy, Long QT syndrome, Wolff-Parkinson-White, anomalous coronary origins — are often detectable by history and ECG before the event[1,3,9]. The Italian cohort study documented an 89% reduction in sudden cardiovascular death following nationwide ECG-inclusive screening[3]. A standard urgent-care sports physical, conducted in 7 minutes with stethoscope alone, is not designed to surface these diagnoses. The 14-element history is. So is ECG. That is the gap SportSlip is built to close.
SportSlip operates as an asynchronous telehealth preparticipation evaluation under physician oversight. Every clearance is personally reviewed and signed by a US board-certified physician licensed in the jurisdiction where the athlete resides[2]. The intake questionnaire instruments the 14-element AHA cardiac history[1], the AAP 4-question SCD screen[20], the PPE-5 musculoskeletal sequence[2], the AMSSM mental-health screen[4], and — for female athletes — the Female Athlete Triad / RED-S framework[11,17]. ECG interpretation, when requested, applies the International Recommendations for Electrocardiographic Interpretation in Athletes (the so-called Seattle / International criteria)[9,10] to differentiate normal athletic adaptation from pathological findings warranting referral.
Blood pressure — the single highest-yield physical-exam-only element — is captured by parent-collected measurement: a recent pediatrician reading, a pharmacy kiosk (CVS, Walgreens), or a home cuff, with the source recorded on intake. Thresholds for review and disqualification follow the AHA/ACC 2015 Task Force 6 hypertension guideline[21]. Marfan stigmata are screened by self-report combined with a structured parent-collected video (T-position arm-span, thumb sign, wrist sign, pectus visual). Functional musculoskeletal assessment is performed via guided video (overhead squat, single-leg squat, box drop jump, heel/toe walk), and a concussion baseline is captured via smooth-pursuit eye tracking and tandem stance with eyes closed.
SportSlip is not a substitute for an established primary-care relationship or for the in-person evaluation indicated when this screen surfaces high-risk findings. When that threshold is met, we issue a referral letter rather than a clearance and refund the visit. Concussion return-to-play decisions follow the 5th International Consensus on Concussion in Sport (Berlin, 2016)[12].
- Maron BJ, Friedman RA, Kligfield P, et al. Assessment of the 12-Lead Electrocardiogram as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age): A Scientific Statement From the American Heart Association and the American College of Cardiology. Circulation. 2014;130(15):1303–1334.
- American Academy of Pediatrics, American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine. Preparticipation Physical Evaluation, 5th Edition. Itasca, IL: American Academy of Pediatrics; 2019.
- Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296(13):1593–1601.
- Drezner JA, O'Connor FG, Harmon KG, et al. AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations and Future Directions. British Journal of Sports Medicine. 2017;51(3):153–167.
- Pelliccia A, Sharma S, Gati S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. European Heart Journal. 2021;42(1):17–96.
- Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden Deaths in Young Competitive Athletes: Analysis of 1866 Deaths in the United States, 1980–2006. Circulation. 2009;119(8):1085–1092.
- Harmon KG, Asif IM, Maleszewski JJ, et al. Incidence and Etiology of Sudden Cardiac Arrest and Death in High School Athletes in the United States. Mayo Clinic Proceedings. 2016;91(11):1493–1502.
- Semsarian C, Ingles J, Maron MS, Maron BJ. New Perspectives on the Prevalence of Hypertrophic Cardiomyopathy. Journal of the American College of Cardiology. 2015;65(12):1249–1254.
- Sharma S, Drezner JA, Baggish A, et al. International Recommendations for Electrocardiographic Interpretation in Athletes. Journal of the American College of Cardiology. 2017;69(8):1057–1075.
- Drezner JA, Ackerman MJ, Anderson J, et al. Electrocardiographic interpretation in athletes: the 'Seattle criteria'. British Journal of Sports Medicine. 2013;47(3):122–124.
- Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad — Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine. 2014;48(7):491–497.
- McCrory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in sport — the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine. 2017;51(11):838–847.
- Corrado D, Pelliccia A, Bjørnstad HH, et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. European Heart Journal. 2005;26(5):516–524.
- Maron BJ, Thompson PD, Ackerman MJ, et al. Recommendations and Considerations Related to Preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update. Circulation. 2007;115(12):1643–1655.
- Asif IM, Drezner JA. Sudden cardiac death and preparticipation screening: the debate continues — in support of electrocardiogram-inclusive preparticipation screening. Progress in Cardiovascular Diseases. 2012;54(5):445–450.
- Lawless CE, Olshansky B, Washington RL, et al. Sports and exercise cardiology in the United States: cardiovascular specialists as members of the athlete healthcare team. Journal of the American College of Cardiology. 2014;63(15):1461–1472.
- De Souza MJ, Nattiv A, Joy E, et al. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad. British Journal of Sports Medicine. 2014;48(4):289.
- Drezner JA, Toresdahl BG, Rao AL, Huszti E, Harmon KG. Outcomes from sudden cardiac arrest in US high schools: a 2-year prospective study from the National Registry for AED Use in Sports. British Journal of Sports Medicine. 2013;47(18):1179–1183.
- Lampert R, Harmon KG. Sudden Cardiac Arrest in Athletes. The New England Journal of Medicine. 2026;394(3):268–280.
- Erickson CC, Salerno JC, Berger S, et al. Sudden Death in the Young: Information for the Primary Care Provider. Pediatrics. 2021;148(1):e2021052044.
- American Heart Association / American College of Cardiology Task Force 6 — Hypertension. Black HR, Sica D, Ferdinand K, White WB, et al. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Hypertension. Circulation. 2015;132(22):e298–e302.
The clinical screen, cited end to end.
Every SportSlip clearance applies the framework jointly endorsed by AAP, AAFP, ACSM, AMSSM, and AOSSM[2], plus the optional ECG layer per the European Society of Cardiology guidelines[3,5,13].
Four parts. Each one cited.
Cardiac history — AHA 14-element[1,6,14]
The American Heart Association's 14-element personal-and-family-history protocol — chest pain on exertion, exercise-related syncope, family history of sudden death under 50, known cardiac conditions, and so on. Designed to surface the cardiomyopathies, channelopathies, and structural anomalies that account for the overwhelming majority of sudden cardiac arrest in athletes under 25.
Musculoskeletal + neurologic — AAP PPE-5[2,12]
The American Academy of Pediatrics' standardized preparticipation evaluation, 5th edition. Joints, mobility, prior injuries, concussion history, return-to-play status. The guided video step walks parent and child through the PPE-5 musculoskeletal sequence — the same Apley scratch, duck-walk, and gait observations a pediatrician runs in person.
Mental health + risk behaviors[4,11,17]
Eating patterns, mood, sleep, substance use. For female athletes: energy availability, menstrual history, and bone-health risk per the Female Athlete Triad / Relative Energy Deficiency in Sport (RED-S) framework. The AMSSM, IOC, and Female Athlete Triad Coalition consensus statements all endorse this screen as part of routine preparticipation evaluation. Most paper sports physicals skip it.
Optional ECG cardiac rhythm screen[3,5,9,10,13]
Italy has required ECG screening for competitive athletes since 1982. The European Society of Cardiology, ESC EAPC, and Seattle/International ECG-interpretation criteria all endorse ECG-inclusive preparticipation screening. Corrado et al.'s 25-year Italian cohort (1979–2004, n=42,386 athletes) documented an 89% reduction in cardiovascular mortality among screened athletes vs. the unscreened general population.
The AAP recommends every child be asked these four questions from age 6[20].
We ask them on every SportSlip intake. Short, specific, lifted directly from the AAP guideline.
- 1
Have you ever fainted, passed out, or had an unexplained seizure suddenly and without warning — especially during exercise or in response to sudden loud noises (doorbells, alarm clocks, ringing telephones)?
- 2
Have you ever had exercise-related chest pain or shortness of breath?
- 3
Has anyone in your family died suddenly and unexpectedly before age 50?
- 4
Has anyone in your family been diagnosed with hypertrophic or dilated cardiomyopathy, long QT syndrome, other ion channelopathies, Marfan syndrome, or clinically significant arrhythmias?
“A 12-lead ECG identifies disorders associated with sudden death from cardiac causes in about two thirds of cases… this approach outperforms history taking and physical examination alone, with a low incidence of false-positive results when contemporary standards for ECG interpretation in athletes are followed.”
The numbers your pediatrician knows.
Direct from the bodies that publish them.
“The 14-element AHA recommendations represent a reasonable and acceptable strategy for screening large populations of competitive athletes in the United States.”
“Preparticipation cardiovascular evaluation including personal and family history, physical examination, and 12-lead ECG is recommended for competitive athletes.”
“The combination of history, physical examination, and 12-lead ECG significantly improves the sensitivity of preparticipation cardiac screening over history and physical alone.”
“Implementation of a nationwide systematic preparticipation screening program with electrocardiogram was associated with a marked reduction in mortality from sudden cardiovascular death in young competitive athletes.”
The specific conditions that cause SCD.
Sudden cardiac arrest in athletes under 35 is almost always attributable to a discrete diagnosis[1,6,14]. These are the highest-yield targets for preparticipation screening.
Hypertrophic cardiomyopathy (HCM)[8]
Autosomal-dominant disorder of the cardiac sarcomere. Single most common cause of athletic SCD in the US per the Maron registry.
Arrhythmogenic right-ventricular cardiomyopathy (ARVC)[3]
Fibro-fatty replacement of right-ventricular myocardium. Disproportionately represented in athletic SCD in Italian cohorts.
Long QT syndrome (LQTS)[1]
Congenital channelopathy causing prolonged ventricular repolarization. Often manifests with exertional or stress-induced syncope.
Wolff-Parkinson-White (WPW)[9]
Accessory atrioventricular conduction pathway. Detectable on resting ECG by characteristic delta wave.
Anomalous origin of a coronary artery[6]
Congenital coronary anatomy that becomes hemodynamically significant during exertion. The second-most-common cause of athletic SCD in some US series.
Marfan syndrome / thoracic aortic disease[1]
Connective-tissue disorder predisposing to aortic root dilation and dissection. Screened on history, family history, and stature/morphology.
Three outcomes. One protocol.
No flags
Signed clearance issued. Valid 12 months across every camp, league, and school form your kid hands you in that window.
One or more flags
Dr. Kawalek personally reviews the entire screen before clearing. May request additional documentation (recent records, medication list, prior cardiology workup) before issuing.
In-person needed
Anything that warrants a real cardiology or orthopedic workup — we don't issue clearance. We provide a referral letter explaining what to ask the specialist, and refund the visit.
Sudden cardiac arrest in young athletes is uncommon — roughly 1 per 80,000 athlete-years in US high schools[7] — but devastating. The Maron registry catalogued 1,866 deaths over 26 years, most during exertion[6]. The conditions responsible are often detectable by history and ECG before the event[1,3,9]. Italy\'s nationwide screening program documented an 89% reduction in cardiovascular death among screened athletes[3]. A 7-minute urgent-care stethoscope visit isn\'t built to find these. The 14-element history is. So is ECG.
SportSlip operates as an asynchronous telehealth preparticipation evaluation under physician oversight. Every clearance is personally reviewed and signed by a US board-certified physician licensed in the jurisdiction where the athlete resides[2]. The intake instruments the 14-element AHA cardiac history[1], PPE-5 musculoskeletal sequence[2], AMSSM mental-health screen[4], and Female Athlete Triad / RED-S framework[11,17].
ECG interpretation, when requested, applies the International Recommendations for Electrocardiographic Interpretation in Athletes[9,10]. Concussion return-to-play decisions follow the 5th International Consensus on Concussion in Sport[12].
- Maron BJ, Friedman RA, Kligfield P, et al. Assessment of the 12-Lead Electrocardiogram as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age): A Scientific Statement From the American Heart Association and the American College of Cardiology. Circulation. 2014;130(15):1303–1334.
- American Academy of Pediatrics, American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine. Preparticipation Physical Evaluation, 5th Edition. Itasca, IL: American Academy of Pediatrics; 2019.
- Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296(13):1593–1601.
- Drezner JA, O'Connor FG, Harmon KG, et al. AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations and Future Directions. British Journal of Sports Medicine. 2017;51(3):153–167.
- Pelliccia A, Sharma S, Gati S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. European Heart Journal. 2021;42(1):17–96.
- Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden Deaths in Young Competitive Athletes: Analysis of 1866 Deaths in the United States, 1980–2006. Circulation. 2009;119(8):1085–1092.
- Harmon KG, Asif IM, Maleszewski JJ, et al. Incidence and Etiology of Sudden Cardiac Arrest and Death in High School Athletes in the United States. Mayo Clinic Proceedings. 2016;91(11):1493–1502.
- Semsarian C, Ingles J, Maron MS, Maron BJ. New Perspectives on the Prevalence of Hypertrophic Cardiomyopathy. Journal of the American College of Cardiology. 2015;65(12):1249–1254.
- Sharma S, Drezner JA, Baggish A, et al. International Recommendations for Electrocardiographic Interpretation in Athletes. Journal of the American College of Cardiology. 2017;69(8):1057–1075.
- Drezner JA, Ackerman MJ, Anderson J, et al. Electrocardiographic interpretation in athletes: the 'Seattle criteria'. British Journal of Sports Medicine. 2013;47(3):122–124.
- Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad — Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine. 2014;48(7):491–497.
- McCrory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in sport — the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine. 2017;51(11):838–847.
- Corrado D, Pelliccia A, Bjørnstad HH, et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. European Heart Journal. 2005;26(5):516–524.
- Maron BJ, Thompson PD, Ackerman MJ, et al. Recommendations and Considerations Related to Preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update. Circulation. 2007;115(12):1643–1655.
- Asif IM, Drezner JA. Sudden cardiac death and preparticipation screening: the debate continues — in support of electrocardiogram-inclusive preparticipation screening. Progress in Cardiovascular Diseases. 2012;54(5):445–450.
- Lawless CE, Olshansky B, Washington RL, et al. Sports and exercise cardiology in the United States: cardiovascular specialists as members of the athlete healthcare team. Journal of the American College of Cardiology. 2014;63(15):1461–1472.
- De Souza MJ, Nattiv A, Joy E, et al. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad. British Journal of Sports Medicine. 2014;48(4):289.
- Drezner JA, Toresdahl BG, Rao AL, Huszti E, Harmon KG. Outcomes from sudden cardiac arrest in US high schools: a 2-year prospective study from the National Registry for AED Use in Sports. British Journal of Sports Medicine. 2013;47(18):1179–1183.
- Lampert R, Harmon KG. Sudden Cardiac Arrest in Athletes. The New England Journal of Medicine. 2026;394(3):268–280.
- Erickson CC, Salerno JC, Berger S, et al. Sudden Death in the Young: Information for the Primary Care Provider. Pediatrics. 2021;148(1):e2021052044.
- American Heart Association / American College of Cardiology Task Force 6 — Hypertension. Black HR, Sica D, Ferdinand K, White WB, et al. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Hypertension. Circulation. 2015;132(22):e298–e302.