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Making a Play: Utilizing Preparticipation Evaluations in Your Practice

February 3, 2023

Preparticipation evaluations (PPE) can be a thorn in the side of many pediatric providers as it seems that August always brings in a flurry of calls to the office with forms that need to be signed before practice starts TOMORROW. This reality is a far cry from the goal of the PPE as a time efficient exam, ideally performed at least 6 weeks before the start of the athletic season (yes, really!), to assess for issues that may become problematic during sport, and to allow for possible remediation before the sports season begins. But it doesn’t always work that way.

In addition to the time crunch described above, several key issues that can interfere with implementation of the PPE are outlined in, “Increasing Utilization of the Preparticipation Physical Evaluation”, early releasing this month in Pediatrics. In this article, Dr. Miliaresis and colleagues from New York Medical College found surprisingly low levels of PPE awareness and implementation (10.1542/peds.2020-049673). A pre-project survey of 430 pediatricians found that only 34% were aware of the PPE, and only 22% actually used it. Through a series of Plan-Do-Study-Act (PDSA) cycles, authors found that provider education and incorporation of the PPE form into the electronic health record were the key factors leading to improvements in PPE performance rates.

The AAP has been a leader in convening expert panels to develop a history and physical examination template for the PPE that has become a de facto standard of care. It must be emphasized that a complete PPE contains far more than just the cardiovascular components described by Miliaresis et al, with the full PPE history and physical evaluation templates available in English and Spanish. These findings complement those from an article published in the December 2022 issue of Pediatrics by Blank and colleagues from Children’s Hospital in Omaha, NE evaluating variability in the cardiovascular content of state forms used for PPE.

Take a look at the Miliaresis article to see a nice description of their use of PDSA cycles as part of their quality improvement efforts, including both process and balancing measures. This would make for a great Maintenance of Certification Part 4 project that could really streamline the PPE process for many practices.

In full disclosure, there is some uncertainty regarding the true value of the PPE, which for many healthy adolescents may be their only touchpoint with the healthcare system. Current recommendations regarding performance of the PPE are based upon a consensus of expert opinion (Level V evidence), and additional outcome studies are sorely needed to better delineate the true value of what has become an annual ritual for many athletes and their providers.

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