What are the goals and objectives of the pre-participation evaluation (PPE)?

The overall goal of the PPE is to help maintain the health and safety of athletes. Its purpose is not to exclude athletes from participation but to promote safe participation. If not cleared, most athletes can be rehabilitated or 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 doctor-athlete contact.

Primary objectives
  • Detect conditions that might predispose the athlete to injury
  • Detect conditions that might 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 advantages of office-based PPEs?

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

What are the advantages of mass PPEs?

These evaluations are less expensive. Multiple specialists can be involved, such as athletic trainers, physical therapists, orthopaedic surgeons, family doctors, and pediatricians who have a special interest in sports medicine.

What are the components of the PPE?

The medical history is the cornerstone of any medical evaluation. A complete history will identify about 75 percent 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
  • Medicines (prescription, over-the-counter, supplements)
  • Allergies (medicines, insects, environmental)
  • Immunization status
  • Menstrual history
  • Psycho-socio-sexual development

Other information about the following should also be included:

  • Cardiovascular
  • Pulmonary
  • Neurologic
  • Musculoskeletal
  • Injuries or illness since last exam
  • History of concussions

The PPE 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 include the following:

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

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 non-exercising 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 muscle wall. Endurance athletes have a lower heart rate.

What is the cause of sudden cardiac death syndrome (SCDS)?

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 might reveal a murmur. The evaluation might include further testing [electrocardiogram (EKG), chest X-ray, stress test, echocardiography] or consultation with a cardiologist.