A standardized process for conducting the preparticipation physical examination is needed to ensure a safe playing environment for athletes and to help identify those conditions that may predispose an athlete to injury or sudden death, says the National Athletic Trainers' Association in a new position statement.
While PPEs - or what used to be called sports physicals - are required as a condition for participation in school sports and are routinely used to identify conditions that put athletes at risk, there has been continued debate as to their effectiveness.
In addition, "the different organizations charged with developing and revising the PPE - from state high school associations to medical associations, state health and education departments to legislators - often have different missions," says Kevin Conley, PhD, ATC, associate professor and director of Athletic Training Education at the University of Pittsburgh and lead author of the statement, "which can lead to confusion."
The issuance by the NATA of a position statement advocating for adoption of its PPE form, however, could have precisely the opposite effect, to the extent it competes with a PPE form developed by six national medical societies in 2010 (PPE Monograph), which at least those medical societies are advocating as the standard towards which the nation should move.
A 2014 survey [1] (Madsen NL, 2014), for instance, found that only 23 states mandate a single statewide form, and only 8 use a form that is consistent with the PPE Monograph, meaning that only 11% of US high school athletes are guaranteed to receive a PPE that is fully consistent with what the medical societies view as a national standard.
Because the PPE represents the sole source of medical evaluation for 30 percent to 88 percent of children and adolescents annually, Conley said the NATA is recommending "a standardized PPE process to determine risk factors and ascertain that athletes are physically and mentally prepared for sports participation."
Based on current and scientific evidence and best practices, the NATA has developed the following PPE guidelines designed for physicians, athletic trainers, and other health care professionals to apply, regardless of the sport or an athlete's performance goals, designed to identify conditions that may threaten the health and safety of participants in organized sports or require further evaluation and intervention, or even disqualification.
A comprehensive medical and family history [2] should be obtained from each participant and remains the cornerstone of the PPE. Research suggests that such a history identifies 75 percent of problems that affect initial athletic participation.
The history should:
A general physical examination is recommended and should include a check of vital signs (e.g. height, weight and blood pressure; visual acuity, cardiovascular/pulmonary, abdominal, neurologic and general medical and musculoskeletal examinations). Although another provider may record the initial vital signs for efficiency, the data should always be reviewed by the physician. Further examination should be based on potential concerns uncovered during the history.
Have you ever passed out during or after exercise? |
Have you ever been dizzy during or after exercise? |
Have you ever had chest pain during or after exercise? |
Did you get tired more quickly than your friends do during exercise? |
Have you ever had racing of your heart or skipped heartbeats? |
Have you ever been told that you have high blood pressure or high chloresterol? |
Have you ever been told that you have a heart murmur? |
Has any family member or relative died of heart problems or of sudden death before age 50? |
Have you had a severe viral infection (for example, myocarditis or mononucleosis) within the last month? |
Has a physician ever denied or restricted your participation in sports for any heart problem? |
The use of routine laboratory or other screening tests such as urinanalysis, complete blood count or chemistry profile during the PPE is not supported by current studies.
However, appropriate tests and screenings may be warranted for athletes who have a history of anemia, diabetes mellitus type 1 or 2, sickle cell trait, [8] cardiovascular conditions or exercise-induced bronchospasms [9]; or are female and have abnormal menstrual cycles.
Clearing an athlete to participate in a sport should be based on previously published guidelines and the best evidence available. Team physicians and institutions have the legal right to restrict an individual from athletic participation, provided the decision is individualized, reasonably made and based on competent medical evidence.
The team physician should review the following questions as to the athlete's ability to meet the criteria for participation:
"A standardized approach to PPEs is most desirable and should be conducted by a licensed physician with the participation of athletic trainers and health care professionals committed to the same standard of care," says Conley. "These suggested guidelines offer a comprehensive approach that we hope will be seriously reviewed and adapted by other sports and health organizations at the state and national levels. Ensuring safe participation and reducing the risk of acute, chronic or catastrophic injury or death remains our primary goal."
For a full copy of the position statement, click here. [14]
Conley KM, Bolin DJ, Carek PJ, Konin JG, Neal TL, Violette D. National Athletic Trainers' Association Position Statement: Preparticipation Physical Examination and Disqualifying Conditions. J Athl Tr. 2014;49(1):102-120. doi:10.4085/1062-6050-48.6.05.
Madsen NL, Drezner JA, Salerno JC. The Preparticipation Physical Evaluation: An Analysis of Clinical Practice. Clin J Sports Med. 2014; 24(2):142-149.
Material from the NATA's press release on the PPE position statement was used in the preparation of this article.
Links:
[1] https://mail.momsteam.com/health-safety/study-finds-few-doctors-schools-states-use-national-preparticipation-physical-evaluation-form-PPE
[2] https://mail.momsteam.com/health-safety/detailed-medical-history-important-part-of-sports-physical-PPE
[3] https://mail.momsteam.com/health-safety/concussion-safety/multiple-concussion-history-important-factor-in-concussion-management
[4] https://mail.momsteam.com/baseline-neurocognitive-testing/baseline-neurocognitive-testing-younger-athletes-extra-vigilance-required
[5] https://mail.momsteam.com/health-safety/retiring-from-sports-after-concussion-no-magic-number
[6] https://mail.momsteam.com/range-motion/physical-therapy-restoring-range-motion-critical-to-avoiding-re-injury-athletic-performance
[7] https://mail.momsteam.com/health-safety/wide-variability-seen-in-return-to-play-decisionmaking-by-doctors
[8] https://mail.momsteam.com/health-safety/exertional-sickling-life-threatening-condition-for-youth-with-sickle-cell-trait
[9] https://mail.momsteam.com/health-safety/exercise-induced-asthma-video-primer-parents
[10] https://mail.momsteam.com/health-safety/energy-drinks-FAQs
[11] http://www.nata.org/sites/default/files/PreventingDetectingAndManagingDisorderedEating.pdf
[12] https://mail.momsteam.com/health-safety/pre-season-heat-acclimatization-guidelines
[13] https://mail.momsteam.com/health-safety/hydration-safety
[14] http://natajournals.org/doi/full/10.4085/1062-6050-48.6.05
[15] https://mail.momsteam.com/health-safety/consistent-use-updated-preparticipation-physical-evaluation-form-goal-of-new-coalition
[16] https://mail.momsteam.com/health-safety/general-safety/pre-participation-evaluations-exams/all-pre-participation-evaluation-fo
[17] https://mail.momsteam.com/team-of-experts/pre-participation-evaluations-a-primer-for-parents
[18] https://mail.momsteam.com/health-safety/general-safety/questions-to-ask-during-pre-participation-physical-evaluation-exam
[19] https://mail.momsteam.com/health-safety/hcm-sudden-cardiac-death-in-young-athletes