Pre-participation History

Aka: Pre-participation History, Preparticipation History, Sports History

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II. Background

  1. Sports History is the most important part of the preparticipation evaluation
    1. Detects 88% of general conditions, and up to 75% of musculoskeletal conditions
  2. Cardiovascular symptoms (e.g. Exertional Syncope, Chest Pain)
    1. Among the most important screening questions and the initial impetus for the preparticipation evaluation
    2. Core cardiovascular screening questions are derived from consensus guidelines (e.g. AHA 14)
      1. Petek (2020) Curr Emerg Hosp Med Rep 8(3): 77-89 +PMID:33552703 [PubMed]
        1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863976/
  3. Sports evaluation is an important contact point address important but neglected psychosocial pitfalls
    1. Mental health screening (e.g. Major Depression, Anxiety Disorder, Substance Abuse, Eating Disorder)

III. History: General

  1. Any new changes in the next year
  2. Hospitalized or surgery
  3. Missing parts (unpaired organs)
  4. Prior sports preparticipation disqualification
  5. Medical problems
    1. Diabetes Mellitus
    2. Mononucleosis (related to Splenomegaly)
    3. Hepatitis
    4. Human Immunodeficiency Virus (HIV)

IV. History: Medication (prescribed and over the counter)

  1. General Medications
    1. Insulin
    2. Anticonvulsants
    3. Antihistamines (Heat Injury risk, Arrhythmia risk)
    4. Doxycycline (Sunburn risk)
    5. Oral Contraceptive use
    6. Inhaled Bronchodilators
    7. NSAID use and over use
  2. Ergonomic aids (Performance supplements)
    1. Weight loss drugs (e.g. Ephedra or Ephedrine)
    2. Anabolic Steroids
    3. Megavitamins
    4. Creatine

V. History: Allergy

  1. Medication allergies
  2. Allergic Rhinitis to Pollens
  3. Anaphylaxis or allergy to Stinging Insects or food
    1. Need for epi-pen?
  4. Exercise induced Urticaria

VI. History: Pulmonary

  1. Diagnosis of Exercise induced Asthma or bronchospasm
  2. Cough during or after Exercise
  3. Excessive or unexplained Shortness of Breath during or after activity (exertional Dyspnea)

VII. History: Cardiovascular

  1. Exertional Syncope or unexplaned Syncope (Blackout, Dizziness)
    1. Hypertrophic Cardiomyopathy
    2. Asthma
    3. Premature Coronary Artery Disease or coronary anomaly
  2. Exertional Chest Pain, chest tightness or chest pressure
  3. Easily Fatigued
    1. Overtraining
    2. Acute or chronic illness
  4. History of Heart Murmur (e.g. Congenital Heart Disease)
  5. History of Hypertension or elevated Blood Pressures
  6. History of Palpitations (Arrhythmia)
    1. Benign (sinus): Gradual onset and better on exertion
    2. SVT: Sudden onset very fast rate, resolved with vagal
    3. Ventricular Tachycardia (e.g. long QT Interval)
    4. Drugs: Tobacco, Caffeine, Alcohol, drugs, supplements
  7. Viral Infection in last month (Myocarditis)
  8. Prior medical provider ordered a cardiac evaluation study
  9. Prior disqualification for heart problem
  10. Family History of Sudden Cardiac Death
    1. Under age 50 years
      1. Premature Coronary Artery Disease
      2. Dilated Cardiomyopathy
    2. Under age 30 years
      1. Hypertrophic Cardiomyopathy
      2. Anomalous Coronary Artery
      3. Marfan's Syndrome
      4. Long QT Syndrome
      5. Genetic cardiac conditions or ion channel channelopathies

VIII. History: Neurologic

  1. Concussions: Knock-outs, Unconscious, Concussion
    1. See Concussion in Sports
    2. Number of lifetime Concussions
    3. Recent Head Injury
    4. Severity of each Head Injury
  2. Seizure history
    1. Is condition controlled?
    2. When was last Seizure?
    3. Anticonvulsants
  3. Neck injury or cervicobrachial injury (e.g. Brachial Plexus Injury)
    1. Have you had a Burner, Stinger or pinched nerve?
  4. Spinal stenosis
    1. Have you ever had extremity numbness or tingling?

IX. History: Environmental Injury

  1. History of Heat Injury
    1. Heat Cramps
    2. Heat Exhaustion
    3. Heat Stroke
  2. Discuss Hydration and Heat Injury prevention
  3. Discuss risk of future Heat Injury

X. History: Musculoskeletal Injury

  1. Joint Injury, Joint dislocation or joint subluxation
  2. Ligamentous Sprain
  3. Tendinous Strain
  4. Prior Fractures
  5. Persistent dysfunction
  6. History of rehabilitation program
  7. Special equipment use for injury prevention
    1. Knee Braces
    2. Neck rolls
    3. Foot Orthotics
    4. Hearing Aids

XI. History: Eye

  1. Eye or Vision problems
    1. Eye loss
    2. Eye Protection
  2. Vision must be corrected 20/40 or better to participate
    1. Eye Glass or Contact Lens use
    2. Protective eyewear (Single eye)

XII. History: Immunization

  1. Immunizations current?
    1. Tetanus Vaccine (Td) at age 12 or 16
    2. Measles Mumps Rubella (MMR) twice
  2. Consider additional Vaccinations if not pregnant
    1. Varicella Vaccine if indicated
    2. Hepatitis B Vaccine

XIII. History: Menstrual

  1. Menarche
  2. Last Menstrual Period
  3. Longest time between periods
  4. Number of Menses in last year

XIV. History: Weight

  1. See Female Athlete Triad
  2. See Relative Energy Deficiency in Sport (RED-S)
  3. See Childhood Obesity
  4. Current weight
  5. Highest weight in last year
  6. Lowest weight in last year
  7. Ideal Weight
  8. What would you like to weigh?
  9. Red Flags for Eating Disorder and Anabolic Steroid use
    1. Low weight for expected Ideal Weight
    2. Recent excessive weight loss
    3. Recent rapid weight gain

XV. History: Social

  1. See HEEADSSS Mnemonic
  2. Stress Confidentiality!
  3. Family problems
  4. Alcohol use
  5. Tobacco Abuse or Vaping
  6. Illicit Drug use and Drug Abuse
    1. See Adolescent Drug Abuse
    2. See Drug Abuse in Athletes
    3. See Sports Performance Supplement
  7. Are you stressed out?
  8. Any problems in school or with friends?
    1. Bullying
  9. Any need for Contraception
  10. Gender Identity
    1. State regulations vary regarding if participation is based on biologic gender or identity
    2. See Transgender Person
  11. Sexually active?
    1. Sexual Abuse
    2. Sexually Transmitted Disease discussion
    3. Need barrier Contraception (Condoms)?
  12. Safety Issues: Seat Belt, Bike Helmet

XVI. Resources

  1. Preparticipation History
    1. https://www.aap.org/en-us/Documents/PPE-History-Form-%28English%29.pdf
  2. Preparticipation History Addendum for Athletes with Disability
    1. https://www.aap.org/en-us/Documents/PPE-Athletes-with-Disabilities-Form.pdf
  3. Preparticipation Exam
    1. https://www.aap.org/en-us/Documents/PPE-Physical-Examination-Form.pdf
  4. Preparticipation Medical Eligibility
    1. https://www.aap.org/en-us/Documents/PPE-Medical-Eligibility-Form.pdf

XVII. References

  1. Kurowski (2000) Am Fam Physician 61(9): 2683-90 [PubMed]
  2. MacDonald (2021) Am Fam Physician 103(9): 539-46 [PubMed]
  3. Mirabelli (2015) Am Fam Physician 92(5): 371-6 [PubMed]

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