II. Background: Pre-participation Exam
- Perform 6-12 weeks before start of practice
- Early exam allows for further evaluation if necessary
- Frequency (varies among states and grade level)
- College: yearly exam
- Middle and High School: Exam at entry of each school
- Use standard Pre-participation Physical forms (e.g. Minnesota State High Schoo Leaguel)
III. Efficacy
- Sports Physical helps prevent sudden death
- Retrospectively studied young athletes from 1979-2004
- Sports Physicals became mandatory in 1982
- Sudden Cardiac Death dropped 89% in screened athletes
- Corrado (2006) JAMA 296:1593-601 [PubMed]
- However, Choosing Wisely Campaign discourages preparticipation physicals
- Sudden Cardiac Death is devastating but rare (1 in 150,000 teen athletes per year, <100 in U.S. per year)
- Preparticipation physical misses many of these cases
- Malhotra (2018) N Engl J Med 379(6): 524-34 [PubMed]
- High False Positive Rate that excludes children from Physical Activity
- High False Negative Rate for Hypertrophic Cardiomyopathy
- References
- Sudden Cardiac Death is devastating but rare (1 in 150,000 teen athletes per year, <100 in U.S. per year)
IV. History: General
- Any new changes in the next year
- Hospitalized or surgery
- Missing parts (unpaired organs)
- Medical problems
- Diabetes Mellitus
- Mononucleosis (related to Splenomegaly)
- Hepatitis
- Human Immunodeficiency Virus (HIV)
V. History: Medication (prescribed and over the counter)
-
General Medications
- Insulin
- Anticonvulsants
- Antihistamines (Heat Injury risk, Arrhythmia risk)
- Doxycycline (Sunburn risk)
- Oral Contraceptive use
- Inhaled Bronchodilators
- NSAID use and over use
- Ergonomic aids (Performance supplements)
- Weight loss drugs (e.g. Ephedra or Ephedrine)
- Anabolic Steroids
- Megavitamins
- Creatine
VI. History: Allergy
- Medication allergies
- Allergic Rhinitis to Pollens
-
Anaphylaxis or allergy to Stinging Insects or food
- Need for epi-pen?
- Exercise induced Urticaria
VII. History: Pulmonary
- Diagnosis of Exercise induced Asthma or bronchospasm
- Cough or Shortness of Breath during or after activity
VIII. History: Cardiovascular
-
Exertional Syncope (Blackout, Dizziness, Chest Pain)
- Hypertrophic Cardiomyopathy
- Asthma
- Premature Coronary Artery Disease or coronary anomaly
- Easily Fatigued
- Overtraining
- Acute or chronic illness
- History of Heart Murmur (Congenital Heart Disease)
- History of Hypertension
- History of Palpitations (Arrhythmia)
- Benign (sinus): Gradual onset and better on exertion
- SVT: Sudden onset very fast rate, resolved with vagal
- Ventricular Tachycardia (e.g. long QT Interval)
- Drugs: Tobacco, Caffeine, Alcohol, drugs, supplements
- Viral Infection in last month (Myocarditis)
- Prior disqualification for heart problem
-
Family History of Sudden death
- Under age 30 years
- Under age 50 years
- Premature Coronary Artery Disease
IX. History: Neurologic
-
Concussions: Knock-outs, Unconscious, Concussion
- Number of lifetime Concussions
- Recent Head Injury
- Severity of each Head Injury
-
Seizure history
- Is condition controlled?
- When was last Seizure?
- Anticonvulsants
- Neck injury or cervicobrachial injury
- Spinal stenosis
- Have you ever had extremity numbness or tingling?
X. History: Environmental Injury
- History of Heat Injury
- Discuss Hydration and Heat Injury prevention
- Discuss risk of future Heat Injury
XI. History: Musculoskeletal Injury
- Joint Injury, Joint dislocation or joint subluxation
- Ligamentous Sprain
- Tendinous Strain
- Prior Fractures
- Persistent dysfunction
- History of rehabilitation program
- Special equipment use for injury prevention
- Knee Braces
- Neck rolls
- Foot Orthotics
- Hearing Aids
XII. History: Eye
- Eye or Vision problems
- Eye loss
- Eye Protection
- Vision must be corrected 20/40 or better to participate
- Eye Glass or Contact Lens use
- Protective eyewear (Single eye)
XIII. History: Immunization
- Immunizations current?
- Consider additional Vaccinations if not pregnant
- Varicella Vaccine if indicated
- Hepatitis B Vaccine
XIV. History: Menstrual
- Menarche
- Last Menstrual Period
- Longest time between periods
- Number of Menses in last year
XV. History: Weight
- Current weight
- Highest weight in last year
- Lowest weight in last year
- Ideal Weight
- What would you like to weigh?
- Red Flags for Eating Disorder and Anabolic Steroid use
- Low weight for expected Ideal Weight
- Recent excessive weight loss
- Recent rapid weight gain
XVI. History: Social
- Family problems
- Illicit Drug use and Drug Abuse
- Alcohol use
- Are you stressed out?
- Any problems in school or with friends?
- Any need for Contraception
- Sexually active?
- Sexually Transmitted Disease discussion
- Need barrier Contraception (Condoms)?
- Safety Issues: Seat Belt, Bike Helmet
- Stress Confidentiality!