II. Epidemiology: Clearance
- Denied participation: 0.3 to 1.3%
- Require further evaluation: 3.2 to 13.5%
- Eventually qualified for some activity: 99%
III. Causes: Items that predict disqualification
- Dizziness with Exercise
- History of Asthma
- High Body Mass Index
- Elevated Systolic Blood Pressure
- Impaired Vision
- Heart Murmur
- Musculoskeletal Findings
- Reference
IV. Approach: General Participation Recommendations
- No contact OR strenuous sports
- Acute Myocarditis or Pericarditis
- Enlarged Spleen
- Fragile during infection (e.g. Mononucleosis)
- May be stable if due to Hereditary Spherocytosis
- Sickle Cell Disease
- Sickle Cell Trait does not contraindicate participation but positive status should be documented
- Sickle Cell Trait exertional sickling may occur with Dehydration, heat with increased sudden death risk
- Risk of Sudden Cardiac Death
- Hypertrophic Cardiomyopathy
- Long QT Syndrome
- Suspected or confirmed Coronary Artery Disease (until cleared)
- Exercise-induced ventricular Dysrhythmia
- Left ventricular systolic ejection fraction <50%
- No contact or Collision Sports
- Liver Enlargement (below level of ribs)
- Spleen Enlargement (Acute OR Chronic stable)
- Cervical or Atlantoaxial Instability (e.g. Down Syndrome, transient upper extremity weakness or Quadriplegia)
- In addition, in swimming, no diving starts, Breaststroke or butterfly
- Bleeding Disorders (e.g. Hemophilia, some forms of von willebrand's syndrome)
- Recent Concussion or post-Concussion findings
- Single Kidney (Consider Flack Jacket)
V. Approach: Special Situations
-
Congenital Heart Disease
- See Bethesda guidelines
- Single Eye or Best corrected Vision worse than 50/20
- No wrestling
- Eye Protection
- Football
- Hockey
- Basketball
- Soccer
- Poorly controlled Seizure Disorder
- No archery, riflery, swimming, weight lifting or sports involving heights (e.g. rock climbing)
- Poorly controlled Insulin Dependent Diabetes Mellitus
-
Severe Uncontrolled Hypertension
- No participation (esp. high Static Sports such as weight lifting) until controlled
-
Eating Disorder
- Non-compliant with therapy and follow-up OR
- Diminished performance or potential injury due to uncontrolled Eating Disorder
- Retinal Detachment
VI. Resources
- Preparticipation Medical Eligibility