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Focus on Subspecialties: Sports physicals: More than a signature :

February 9, 2016

The preparticipation physical evaluation (PPE) or sports physical is an important step in keeping kids healthy and active, yet it often is looked upon by athletes, parents and coaches as just another form to be signed.

There are good reasons the PPE is required in nearly every state. Its main objective is to screen for life-threatening conditions or those that may lead to injuries or illness. It also is helpful in determining the young athlete’s general health.

Sports physicals screen for life-threatening conditions or those that may lead to injuries or illness.Sports physicals screen for life-threatening conditions or those that may lead to injuries or illness.

In addition to these goals, the PPE has other benefits. The only time many adolescents see their primary care provider is for a sports physical. Therefore, the PPE is a good entry point to get teens into the health care system, to help screen for other conditions (e.g., depression) and provide anticipatory guidance.

Furthermore, the PPE is important for all youths regardless of whether they participate in organized sports. A young person who plays recreational sports outside of school or with friends on the playground is not at any lower risk for some of the life-threatening or life-altering conditions screened for than one who participates in a school-sponsored sport.

In addition, 70% of young athletes leave organized sports by 13 years of age, and many youth sports leagues do not require a PPE.

Therefore, pediatricians should perform PPEs on all children and adolescents as part of well visits and address the same questions critical to the PPE.

Following are answers to some questions clinicians may have about the PPE.

What is the best setting for a PPE?

The 4th edition of the monograph Preparticipation Physical Evaluation, co-authored by the Academy, strongly recommends that the PPE be done in the medical home. The pediatrician has an established relationship with the athlete and knows his or her medical history, including family history, immunizations and laboratory studies. The pediatrician also has access to reports from other medical subspecialists that may contain information that could affect the athlete’s health and ability to participate safely.

The physician’s office also provides privacy and a chance to discuss confidential matters that would not be possible in other settings.

Often, however, exams are performed in the school setting because they are more convenient or affordable for students who do not have a personal physician, lack health insurance or have transportation difficulties. These barriers can be overcome for a large proportion of children, since they should qualify for health insurance in most states. It is a matter of helping the family find insurance coverage and choose a pediatrician.

Ultimately, a young person should not miss out on participating in sports or recreational activities due to lack of health insurance or a personal physician. Therefore, a coordinated medical team setting may be helpful. The setting should allow for privacy and a quiet environment. One health care provider should review the athlete’s history and perform the physical examination. Ideally, a parent would be present during the examination or at a minimum assisted with completion of the medical history form.

What forms should be used?

While 98% of the states require a PPE, only 53% mandate a specific form.

Many of the required forms lack critical questions. A 2015 study found that only 43% of state forms addressed all of the recommended personal and family cardiovascular screening questions (Caswell SV, et al. Pediatrics. 2015;135:26-32,

It is recommended that history and physical forms published in the PPE monograph should be used (see resources), or all of the information on these forms should be included.

The health history is the most critical part of the form as close to 90% of medical and musculoskeletal conditions are diagnosed based on history. The athlete and parent should complete the forms together, as studies show only 20%-40% of athletes’ responses agreed with the information given by their parents completing the form.

When should the exam be performed?

It is recommended that the PPE be performed at least six weeks prior to the start of preseason practice or tryouts to allow time to complete any additional testing or consultation that may be required.

Some states require that the PPE be performed after an arbitrary date for administrative purposes. To encourage the PPE to be done in the medical home, pediatricians should advocate that their state allow the exam to be completed on an annual basis, with no date requirement. The exam and form then could be completed during the student’s yearly well visit.

Dr. Brenner is a member of the AAP Council on Sports Medicine and Fitness.

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