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Preparticipation Physical Evaluation
Aka: Preparticipation Physical Evaluation, Sports Physical, Adolescent Athlete
- See Also
- Pre-participation History
- Pre-participation Exam
- Pre-participation Special Circumstances
- Station Divided Sports Physical
- Sports Participation Disqualifiers
- Sports Contact Levels (Contact Sport or Collision Sport)
- Sports Intensity Levels (Dynamic Sports, Static Sports)
- Athletic Heart Syndrome
- Arrhythmias in Athletes
- Sudden Death in Athletes
- Epidemiology
- Sports participation among children and teens in U.S.
- Prevalence Overall: 60 Million
- Prevalence High School: 7.9 Million
- Sports participation declines steadily ages 10-18 years
- Fun is most important
- Winning not a major benefit
- 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)
- http://www.mshsl.org/mshsl/publications/code/forms/physicalExam.pdf
- Efficacy
- Preparticipation Physical guidelines are a consensus among all major related U.S. professional organizations
- General organizations include AAFP, AAP
- Sports medicine associations include ACSM, AMSSM, AOSSM, AOASM
- Preparticipation Exam is in 5th edition as of 2021 (PPE5)
- 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]
- Required by most high school and college athletic programs (NFHS, NCAA)
- Preparticipation Physical guidelines recommend before participation and every 2-3 years
- Annual updates needed only for specific concerns
- Guidelines vary by state, and many high schools require annual Sports Physicals despite national guidelines
- 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
- Rowin (2012) Am J Cardiol 110(7): 1027-32 [PubMed]
- High False Negative Rate for Hypertrophic Cardiomyopathy
- Halkin (2012) J Am Coll Cardiol 60(22):2271-6 [PubMed]
- May be a barrier to participation in socioeconomically or medically disadvantaged communities
- May not be covered by insurance (may be combined with preventive Health Maintenance)
- References
- Schefft (2019) Am Fam Physician 99(6): 376-82 [PubMed]
- Electrocardiogram (EKG)
- Some countries (e.g. Israel) have instituted universal EKGs with the Sports Physical
- Goal is to prevent Sudden Cardiac Death (some present with Exertional Syncope)
- Current U.S. guidelines recommend EKG only when indicated by history or exam findings
- See Sports Physical Exam
- See Sports Physical Special Circumstances
- Petek (2020) Curr Emerg Hosp Med Rep 8(3): 77-89 +PMID:33552703 [PubMed]
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863976/
- EKG does increase Test Sensitivity of preparticipation evaluation (from Test Sensitivity 30% to 50%)
- However EKG has False Positive Rate (up to 40%) and False Negative Rate (10% for Hypertrophic Cardiomyopathy)
- NNT to prevent one cardiac death is 33,000 to 192,000
- EKG False Positive Rate often arises from normal physiologic cardiac remodeling in response to regular intensive Exercise
- See Normal Electrocardiogram Changes in Athletes (Athletic Heart Syndrome)
- See Arrhythmias in Athletes
- References
- Estes (2012) Prog Cardiovasc Dis 54(5):451-4 +PMID:22386297 [PubMed]
- O'Connor (2010) J Athl Train 45(3): 265-72 +PMID:20446840 [PubMed]
- Schefft (2022) Am Fam Physician 105(3): 302-6 [PubMed]
- History
- See Pre-participation History
- Most important part of the Sports Physical (detects 88% of general, and up to 75% of musculoskeletal conditions)
- Exam
- See Pre-participation Exam
- Station Divided Sports Physical
- Evaluation
- See Pre-participation Special Circumstances
- See Sports Participation Disqualifiers
- See Sports Contact Levels (Contact Sport or Collision Sport)
- See Sports Intensity Levels (Dynamic Sports, Static Sports)
- Associated Conditions
- See Sports Related Trauma
- Cardiovascular Conditions in Athletes
- Athletic Heart Syndrome
- Arrhythmias in Athletes
- Sudden Death in Athletes
- Syncope in Athletes
- Psychiatric Illness in Athletes
- Depression in Athletes
- Drug Abuse in Athletes
- Female Athlete Triad (Anorexia or Bulimia)
- Exercise addiction
- Overtraining
- Resources
- Preparticipation History
- https://www.aap.org/en-us/Documents/PPE-History-Form-%28English%29.pdf
- Preparticipation History Addendum for Athletes with Disability
- https://www.aap.org/en-us/Documents/PPE-Athletes-with-Disabilities-Form.pdf
- Preparticipation Exam
- https://www.aap.org/en-us/Documents/PPE-Physical-Examination-Form.pdf
- Preparticipation Medical Eligibility
- https://www.aap.org/en-us/Documents/PPE-Medical-Eligibility-Form.pdf
- Prevention
- See Nutrition for Athletes
- See Sports Eye Protection
- References
- MacDonald (2021) Am Fam Physician 103(9): 539-46 [PubMed]