Do preparticipation clinical exams reduce morbidity and mortality for athletes?

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Clinical Inquiries

Do preparticipation clinical exams reduce morbidity and mortality for athletes?

J Fam Pract. 2005 July;54(7):621-634

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References

1. Wingfield K, Matheson GO, Meeuwisse WH. Preparticipation evaluation: an evidence-based review. Clin J Sport Med 2004;14:109-122.

2. Lyznicki JM, Nielsen NH, Schneider JF. Cardiovascular screening of athletes. Am Fam Physician 2000;62:765-774.Erratum in: Am Fam Physician, 2001; 63:2332.

3. Maron BJ, Shirani J, Poliac LC, Mathenge R, Roberts WC, Mueller FO. Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. JAMA 1996;276:199-204.

4. Hallstrand TS, Curtis JR, Koepsell TD, et al. Effectiveness of screening examinations to detect unrecognized exercise-induced bronchoconstriction. J Pediatr 2002;141:343-348.

5. DuRant RH, Pendergrast RA, Seymore C, Gaillard G, Donner J. Findings from the preparticipation athletic examination and athletic injuries. Am J Dis Child 1992;146:85.-

6. Maron BJ, Thompson PD, Puffer JC, et al. Cardiovascular preparticipation screening of competitive athletes. A statement for health professionals from the Sudden Death Committee (clinical cardiology) and Congenital Cardiac Defects Committee (cardiovascular disease in the young), American Heart Association. Circulation 1996;94:850-856.

7. Smith DM. American Academy of Family Physicians, Preparticipation Physical Evaluation Task Force. Preparticipation Physical Evaluation. 3rd ed. Minneapolis: McGraw-Hill Healthcare; 2004.

Recommendations from others

The AHA recommends a national standard for PPE and that screening should be mandatory for all high school and college athletes before participation in organized sports, with screening repeated every 2 years, and an interim history obtained during the intervening years. Specific items are given in the TABLE.⁶

In 2004, the American Academy of Family Physicians, along with the American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopedic Society for Sports Medicine, and the American Osteopathic Academy of Sports Medicine, published recommendations for PPEs. They suggested a detailed history (consisting of a 16-point questionnaire incorporating AHA recommendations for cardiovascular screening), limited medical exam, and a detailed musculoskeletal exam evaluating strength, flexibility, and stability of major joints.⁷

TABLE
AHA recommendations for preparticipation exams

CARDIOVASCULAR SCREENING QUESTIONS
Have you ever become dizzy or passed out during or after exercise? Have you ever had chest pain during or after exercise? Do you get tired more quickly than your friends do during exercise? Have you ever had racing of your heart or skipped heartbeats? Have you ever had high blood pressure or high cholesterol? Have you ever been told that you have a heart murmur? Has any family member or relative died of heart problems or sudden death before age 50? Have you had a severe viral infection such as mononucleosis or myocarditis within the last month? Has a physician ever denied or restricted your participation in sports for any heart problems? Have any of your relatives ever had any of the following conditions: Hypertrophic cardiomyopathy Dilated cardiomyopathy Marfan’s syndrome Long QT syndrome Significant heart arrhythmia
CARDIOVASCULAR SCREENING EXAM
Recognition of the physical manifestations of Marfan’s Syndrome Blood pressure, seated position Palpation of radial and femoral pulses Cardiac exam to include rate, rhythm and characterization of murmurs and abnormal heart sounds. Precordial auscultation supine Precordial auscultation standing Maneuvers to clarify murmurs such as squat-to-stand, deep inspiration, or ValsalvaM
CARDIAC FINDINGS REQUIRING FURTHER EVALUATION
Murmur grade 3/6 or greater Diastolic murmur Murmur that increases with Valsalva or other maneuver

CLINICAL COMMENTARY

The PPE provides us an opportunity to address preventive health issues
Beth Anne Fox, MD, MPH
East Tennessee State University, Kingsport Family Medicine Residency, Kingsport, Tennessee

Most physicians involved in screening athletes recognize the limitations of PPEs in detecting those at risk for sports-related morbidity and mortality. The history is the most important part of the examination for identifying athletes who might be at risk and should be thorough. Prepared PPE forms such as those endorsed by the AAFP and ACSM can assist in obtaining this history. Because this may be the only occasion for the athlete to see a physician, the examination is best performed by a primary care provider who can use the opportunity to address preventive health issues such as tobacco, alcohol, and drug use, depression and suicidality, sexuality, nutrition, and accident prevention. This kind of counseling is difficult to do in a group format.

Evidence-based answers from the Family Physicians Inquiries Network

Do preparticipation clinical exams reduce morbidity and mortality for athletes?

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