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Point-counterpoint: Sports medicine experts to explore preparticipation exam controversies :

September 27, 2018

Editor's note:The 2018 AAP National Conference & Exhibition will take place from Nov. 2-6 in Orlando.

Young athletes stream into your office for a sports preparticipation physical evaluation (PPE), form in hand.

“I think we all agree now that … it (the PPE) shouldn’t be done in the way you might think about it from the old days, lining all the kids up in a gym in their shorts and a T-shirt and sort of walking down the line,” said Keith J. Loud, M.D.C.M., M.Sc., FAAP, a member of the AAP Council on Sports Medicine and Fitness (COSMF) and chair of the Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock, Lebanon, N.H.

Yet, plenty of other issues regarding the PPE are open to debate: What should the exam entail? Where should it be performed? Does it prevent injuries and sudden cardiac death?

Dr. Loud and COSMF member David T. Bernhardt, M.D., FAAP, will square off on these and other questions during a point-counterpoint session titled “Sports Preparticipation Evaluations: Screening Controversies (D2014)” from 8-9 a.m. Sunday, Nov. 4 in room W304AB of the convention center.  

For years, pediatricians have turned to the Preparticipation Physical Evaluation monograph to guide their exams of athletes in middle school through college.

“The utility of the EKG is probably the most controversial part of the monograph, and it’s probably the most controversial part of the preparticipation evaluation,” said Dr. Bernhardt, co-editor of the 4th edition and professor in the Departments of Pediatrics and Orthopedics and Rehabilitation at University of Wisconsin School of Medicine and Public Health. “There are proponents in sports medicine and among pediatric cardiology who would feel that everybody should have an EKG. There are other people that think you should do targeted EKG screening for high-risk populations. And there are people who think no screening should be done at all. That will definitely be a highlight of this talk.”

The pair also will debate the utility of screening for other conditions such as anemia, sickle cell trait, vitamin D status, depression and anxiety.

Weaknesses notwithstanding, Dr. Loud and Dr. Bernhardt agree that the PPE is a valuable tool.

“The adolescent really is coming in to have the preparticipation evaluation form signed because they can’t play sports without it,” Dr. Bernhardt said. “And if they weren’t coming in to have that form signed, it’s unlikely that they would necessarily come in for a well-adolescent visit at all in many places.”

Added Dr. Loud: “The PPE is one of the largest population-based screening initiatives we perform in U.S. health care, and this session will help primary care providers understand its strengths and weaknesses but reassure them that they can and should perform it within context of their medical home practices.”

For more coverage of the 2018 AAP National Conference & Exhibition visit and follow @AAPNews on Twitter and Facebook.

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