Right axis deviation as a criterion for echocardiographic evaluation of aircrew candidates

BACKGROUND: Significant pressures exist in the resource-limited environment of military aviation to select only those candidates for flight training who are both physically able to withstand the demands of the flight environment and likely to complete a career in aviation. As medical technology has advanced, uncertainty has arisen regarding the appropriate use of additional studies in the screening of aircrew candidates. At the Naval Operational Medicine Institute (NOMI), where all U.S. Navy aviation duty candidates' medical qualifications are reviewed, current policy is to perform 2D-echocardiography on all candidates who exhibit a right axis deviation of +95 degrees or greater on their initial electrocardiogram. METHODS: The records of all aircrew candidates referred to the Department of Internal Medicine for evaluation of right axis deviation during the years 1993, 1994, and 1995 were reviewed. A cost benefit analysis was performed to assess the cost effectiveness of using echocardiography to screen candidates suspected of having disqualifying physical defects based on a finding of right axis deviation on electrocardiogram. RESULTS: Of the 69 cases reviewed, only 1 candidate was disqualified due to cardiovascular disease. He suffered from a large atrial septal defect initially discovered on physical examination. CONCLUSIONS: It is not cost effective to use 2D-echocardiography to screen aircrew candidates for disqualifying cardiac defects based on a finding of a right axis deviation of +95 degrees or greater on electrocardiogram.