National Athletic Trainers’ Association Position Statement: Preparticipation Physical Examinations and Disqualifying Conditions

http://www.nata.org/sites/default/files/Conley.pdf

Objective:

To present athletic trainers with recommendations for the content and administration of the preparticipation physical examination (PPE) as well as considerations for determining safe participation in sports and identifying disqualifying conditions.

Background:

Preparticipation physical examinations have been used routinely for nearly 40 years. However, considerable debate exists as to their efficacy due to the lack of standardization in the process and the lack of conformity in the information that is gathered. With the continuing rise in sports participation at all levels and the growing number of reported cases of sudden death in organized athletics, the sports medicine community should consider adopting a standardized process for conducting the PPE to protect all parties.

Recommendations:

Recommendations are provided to equip the sports medicine community with the tools necessary to conduct the PPE as effectively and efficiently as possible using available scientific evidence and best practices. In addition, the recommendations will help clinicians identify those conditions that may threaten the health and safety of participants in organized sports, may require further evaluation and intervention, or may result in potential disqualification.

Summary:

  • Every athlete needs a complete medical and family history and needs to be reviewed by AT
  • Special consideration to questions regarding:
    • Exertional chest pain/discomfort
    • Syncope or near syncope episode
    • Blood pressure
    • Unexplained fatigue with exertion
    • Family history of sudden death before the age of 50
    • Certain cardiac conditions in family members: HCM, long QT syndrome, Marfans, etc
    • Heart murmur on examination
    • Physical signs of Marfan’s
    • Decreased femoral pulses
  • Special evaluation considerations should be used for recent surgical/injured areas
  • A limited general examination is sufficient for a PPE; include the following:
    • Vital signs
    • Snellen exam
    • Cardiovascular
      • Auscultation of the heart should be performed supine and standing
      • ECG and Stress echo’s are not warranted for a routine PPE
    • Orthopedic
      • The musculoskeletal history screening and examination can be combined for asymptomatic athletes with no previous injuries
      • Any abnormal findings warrant a more further exam
    • Neurological
      • History of seizures, concussions, spinal injuries would merit further and more complete neurological testing
    • General Medical
      • Diabetic athletes should routinely have foot examinations along with a diabetic action plan for safe glucose levels during exercise
      • Females with abnormal menses or absence of menses are recommended for further follow up and testing
      • Confirm testing for sickle cell trait/disorder
      • All medicines being taken by the athlete should be listed in the athlete’s medical file and be reviewed
      • Review BMI and history for possible eating disorders
      • Consider mental health questions to determine athlete’s mental health status
    • Administration of PPE
      • Respect the privacy of all athletes; FERPA, HIPPA
      • PPEs can be completed 4-6 weeks ahead of participation to allow for follow up testing as needed; or completed closer to the participation start date knowing that some athletes may need additional testing and will not be cleared on the start date
      • A complete PPE is required for each new level of participation; ex. High school to junior college= new PPE, 1st year junior college to 2nd year junior college= review of medical history
      • A licensed physician should complete and sign the PPE
      • All athletes should be cleared with the best evidence available
      • Team physicians and institutions have the legal right to disqualify an athlete provided the decision is individualized, reasonably made, and based on competent medical evidence

 

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