The Preparticipation Sports Evaluation

 


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Am Fam Physician. 2015 Sep 1;92(5):371-376.

  Related editorials: Should Preparticipation Cardiovascular Screening of Athletes Include ECG? Yes: Screening ECG Is Cost-Effective and No: There Is Not Enough Evidence to Support Including ECG in the Preparticipation Sports Evaluation.

  Related letter: The Preparticipation Sports Evaluation: Losing the Forest for the Trees?

Author disclosure: No relevant financial affiliations.

The preparticipation physical evaluation is a commonly requested medical visit for amateur and professional athletes of all ages. The overarching goal is to maximize the health of athletes and their safe participation in sports. Although studies have not found that the preparticipation physical evaluation prevents morbidity and mortality associated with sports, it may detect conditions that predispose the athlete to injury or illness and can provide strategies to prevent injuries. Clearance depends on the outcome of the evaluation and the type of sport (and sometimes position or event) in which the athlete participates. All persons undergoing a preparticipation physical evaluation should be questioned about exertional symptoms, presence of a heart murmur, symptoms of Marfan syndrome, and family history of premature serious cardiac conditions or sudden death. The physical examination should focus on the cardiovascular and musculoskeletal systems. U.S. medical and athletic organizations discourage screening electrocardiography and blood and urine testing in asymptomatic patients. Further evaluation should be considered for persons with heart or lung disease, bleeding disorders, musculoskeletal problems, history of concussion, or other neurologic disorders.

Approximately 30 million athletes younger than 18 years and another 3 million athletes with special needs receive medical clearance to participate in sports every year.1 The purpose of the preparticipation physical evaluation (PPE) is to maximize the health of athletes and their safe participation in sports. The most comprehensive guideline on the PPE is the 4th edition of the American Academy of Pediatrics' PPE recommendations, which contains consensus recommendations and has been endorsed by multiple stakeholder medical societies.2 Although studies have not found that the PPE prevents morbidity and mortality associated with sports participation,2 it may detect conditions that predispose the athlete to injury or illness and can provide strategies to prevent injuries.3

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Preparticipation physical evaluations should occur approximately six weeks before activity to allow for further evaluation, treatment, or rehabilitation as needed.

C

4

All persons undergoing preparticipation physical evaluations should be questioned about exertional symptoms, the presence of a heart murmur, symptoms of Marfan syndrome, and family history of premature serious cardiac conditions or sudden death.

C

13, 16

Athletes with sustained systolic blood pressure of less than 160 mm Hg and diastolic blood pressure of less than 100 mm Hg should not be restricted from playing sports.

C

25

Athletes with well-controlled asthma who are asymptomatic at rest and with exertion can be safely cleared to play sports.

C

26

Screening blood and urine tests are not recommended for asymptomatic athletes.

C

37


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Preparticipation physical evaluations should occur approximately six weeks before activity to allow for further evaluation, treatment, or rehabilitation as needed.

C

4

All persons undergoing preparticipation physical evaluations should be questioned about exertional symptoms, the presence of a heart murmur, symptoms of Marfan syndrome, and family history of premature serious cardiac conditions or sudden death.

C

13, 16

Athletes with sustained systolic blood pressure of less than 160 mm Hg and diastolic blood pressure of less than 100 mm Hg should not be restricted from playing sports.

C

25

Athletes with well-controlled asthma who are asymptomatic at rest and with exertion can be safely cleared to play sports.

C

26

Screening blood and urine tests are not recommended for asymptomatic athletes.

C

37


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

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BEST PRACTICES IN PREVENTIVE MEDICINE: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Do not order annual electrocardiography or any other cardiac screening for asymptomatic, low-risk patients.

American Academy of Family Physicians and American College of Physicians

Do not screen adolescents for scoliosis.

American Academy of Family Physicians


Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org. For supporting citations and to search Choosing Wisely recommendations relevant to primary

The Authors

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MARK H. MIRABELLI, MD, is an assistant professor in the Departments of Orthopaedics, Family Medicine, and Physical Medicine and Rehabilitation at the University of Rochester (N.Y.) Medical Center....

MATHEW J. DEVINE, DO, is an assistant professor in the Department of Family Medicine at the University of Rochester Medical Center.

JASKARAN SINGH, MD, is in private practice in Brampton, Ontario. At the time this article was written, he was a resident in the Department of Family Medicine at the University of Rochester Medical Center.

MICHAEL MENDOZA, MD, MPH, MS, is an assistant professor in the Department of Family Medicine at the University of Rochester Medical Center.

Address correspondence to Mark H. Mirabelli, MD, University of Rochester, 601 Elmwood Ave., Box 665, Rochester, NY 14642 (e-mail: mark_mirabelli@urmc.rochester.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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