What are the goals and objectives of the preparticipation evaluation?

The overall goal of the preparticipation evaluation (PPE) is to help maintain the health and safety of the athlete. Its purpose is not to exclude athletes from participation but to promote safe participation. If not cleared, most athletes can be redirected to another sport. This goal is achieved by adhering to the evaluation's three primary objectives. The three secondary objectives take advantage of the physician-athlete contact.

Primary objectives

  • Detect conditions that may predispose the athlete to injury
  • Detect conditions that may be life threatening or disabling
  • Meet legal and insurance requirements

Secondary objectives

  • Determine general health
  • Counsel on health-related issues
  • Assess fitness level for specific sports

What are the appropriate time, setting, and structure of the preparticipation evaluation?

Ideally, the PPE should be performed at least 6 weeks prior to preseason practice, allowing time for correction or rehabilitation of any identified problems. To avoid potential scheduling difficulties, the PPE may be performed at the end of the previous school year.

Opinions vary regarding how often the young athlete needs to be evaluated. In some high schools, a full annual evaluation is the norm. Another option, followed primarily at the college level, is a complete evaluation at an entry or new level, followed by an interim annual evaluation.

The two most common settings for performing the PPE are the physician's office or in a station-based screening environment.

What are the advantages of mass preparticipation screening evaluations?

These evaluations are less expensive. Multiple specialists can be involved (athletic trainers, physical therapists, orthopaedic surgeons, family physicians, pediatricians); these individuals have a special interest in sports medicine.

What are the advantages of office-based preparticipation physical examinations?

An office-based exam is usually performed by the athlete's primary care physician. The physician is familiar with the athlete's medical history and family history. The setting is much quieter and allows for discussion of multiple health issues, which are pertinent to adolescents, including use of drugs, supplements and alcohol, sexual activity and other topics. Immunization history can be reviewed and updated accordingly.

What are the components of the preparticipation evaluation?

The medical history is the cornerstone of any medical evaluation. A complete history will identify approximately 75% of problems affecting athletes. To increase the information obtained, the athlete and parent should complete the history together before the examination. The recommended baseline history includes the following general information:

  • Medical conditions and diseases
  • Surgeries
  • Hospitalizations
  • Medications (prescription, over-the-counter, supplements)
  • Allergies (medications, insects, environmental)
  • Immunization status
  • Menstrual history
  • Psycho-socio-sexual

Other information about the following should also be included:

  • Pulmonary
  • Neurologic
  • Musculoskeletal
  • Injuries or illness since last exam

The PPE physical examination is a screening tool that emphasizes the areas of greatest concern in sports participation and areas identified as problems in the history. The recommended standard components of the PPE physical examination includes the following:

  • Height
  • Weight
  • Pulse
  • Blood pressure
  • Eyes
  • Ear/nose/throat
  • Heart
  • Abdomen
  • Genitalia
  • Skin
  • Musculoskeletal

What is involved in determining clearance for participation in sports?

The most important and difficult decision in the PPE is determining whether an athlete should be cleared for sports participation. Clearance can be divided into three categories: (1) unrestricted clearance, (2) clearance after completion of further evaluation or rehabilitation, and (3) no clearance for certain types of sports or for all sports. When an abnormality or condition is found that may limit an athlete's participation or predispose him or her to further injury, the physician must consider the following questions:

  • Does the problem place the athlete at increased risk for injury?
  • Is another participant at risk for injury because of the problem?
  • Can the athlete safely participate with treatment?
  • Can limited participation be allowed while treatment is being completed?
  • If clearance is denied only for certain sports or sports categories, in what activities can the athlete safely participate?

To aid in this decision, sports are classified based on degree or level of contact and strenuousness.

  • Contact/collision
  • Limited contact
  • Strenuous, noncontact
  • Moderately strenuous, noncontact
  • Nonstrenuous, noncontact

What is athletic heart syndrome?

The heart of an athlete undergoes certain functional and morphological changes (physical size and shape) that distinguish it from the heart of nonexercising individuals. These changes represent a normal physiologic response to exercise and not a disease process. The type and degree of change is affected by the type of training, endurance (aerobic) versus strength (isometric). Endurance athletes have an increased left ventricular volume and cardiac output; strength athletes have an increase in thickness of the heart wall muscle. Endurance athletes have a lower heart rate.

What is the cause of sudden cardiac death syndrome?

Sudden death in the athlete under the age of 35 is most commonly due to congenital heart disease. Usually the athlete is male, has been involved in a variety of sports and is at the junior high or high school level. Unfortunately, there are usually no preceding symptoms.

How can the athlete at risk for SCDS be identified?

The PPE history is designed to identify athletes at risk, such as those with chest pain or heaviness, palpitations, shortness of breath, fainting spells (syncope) or family history of sudden death. Any athlete with these symptoms requires full evaluation. The PPE physical examination may reveal a murmur. The evaluation may include further testing [electrocardiogram (EKG), chest X-ray, stress test, echocardiography] or consultation with a cardiologist.