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Vital Signs Before Preemployment and Functional Testing: An Observational Study

Purpose: To test the impact of pretest blood pressure (BP) and heart rate (HR) screening criteria used to determine risk of adverse events (AEs) during preemployment functional testing for jobs in the “medium” to “very heavy” physical demand categories. Methods: Retrospective analysis of functional testing data collected from 2005 to 2012 at 990 regional service clinics for 37 employers on job applicants from 16,511 zip codes across all the US states and the District of Columbia. Results: Data on 269,527 subjects demonstrate that failure rates [99% CIs] for BP screening criteria based on general health risk (GHR) are much higher when compared with screening criteria–based risk of AEs during testing. Using systolic BP and diastolic BP, first trial failure rate (% [99% CI]) increased from 1.74 [1.66, 1.78] when based on AE to 39.31 [39.07, 39.55] when based on GHR. Of subjects that took the functional test but failed GHR screening criteria (MAP ≥ 106 mm Hg), 27.18% [26.73, 27.63] failed functional testing and no subjects experienced an AE during the functional testing. Conclusions: Screening criteria based on GHR intended to be predictive of future disease risk is too stringent as a screening criteria for preemployment functional testing and may unduly penalize job applicants by delaying the opportunity for functional preemployment testing. Further work is needed to identify safe boundaries and risk factors of an AE during functional testing besides use of isolated vital signs such as BP and HR.