One of the most important parts of the preparticipation physical exam (PPE) most sports programs require is the taking of a complete medical history. Before scheduling the appointment make certain of the approved medical professionals (usually an MD) . Regardless of what PPE form their child's program uses, the following questions should be asked during the pre-participation physical evaluation or exam (e.g. sports physical):
1. Family medical history. Has anyone in the athlete's family:
- Died for no apparent reason before age 50 (SIDS, unexplained car accident, drowning)?
- Had a heart problem, pacemaker, or implanted defibrillator?
- Died of heart problems or sudden cardiac arrest before age 50?
- Had syncope (fainting) or presyncope (near fainting)?
- Had unexplained seizures?
- Had significant arrhythmia (irregular heartbeat) or a pacemaker?
- Had any of the following genetic disorders:
- Hypertrophic cardiomyopathy (HCM). Note, however, that one study found that only 25% of athletes with HCM who died of sudden cardiac death had a family history of one or more non-traumatic familial deaths at age 50 or younger.
- Dilated cardiomyopathy (DCM)
- Marfan syndrome
- Ehlers-Danlos syndrome
- Arrythmogenic right ventricular cardiomyopathy
- Brugada syndrome
- Long QT syndrome (LQTS)
- Short QT syndrome
- Primary pulmonary hypertension
- Rheumatic fever
- Hypertension (high blood pressure) or
- Kawaski disease?
2. Personal Medical History
- Has the child ever experienced:
- Chest pain with or without exercise?
- Excessive, unexpected, or unexplained fatigue with exercise?
- Excessive, unexpected, or unexplained shortness of breath with exercise? (Note: doctors don't always recognize this as a symptom of congenital heart disease, sometimes mistaking it for exercise-induced asthma. In one case, a 15-year-old boy was pulled out of a soccer game because of shortness of breath and later diagnosed with asthma. A month later, he suffered sudden cardiac death on a soccer field as a result of HCM)
- Unexplained seizure?
- Heart palpitations (heart races or skips beats) during exercise?
- Past detection of a heart murmur or high blood pressure?
- Has the child been told by a doctor that he/she had any heart problems (high blood pressure, heart murmer, high cholesterol, heart infection, Kawasaki disease.
- Has a doctor ever denied or restricted the child's participation in sports for any reason?
- Has a doctor ever ordered heart tests for the child (ECG/EKG, echocardiogram?
- Had skin problems (warts, fungus, blisters, boils or skin infections)
- Has the athlete experienced or is he experiencing:
- Had a heat illness
- Have asthma or seasonal allergies (asthma should be suspected in any athlete with a history of wheezing during sports)
- Have diet or weight concerns (i.e. eating disorders)
3, Psychosocial Issues:
- home life and family dynamics
- school performance and relationships
- activities (sports, jobs, and leisure enjoyment
- safety issues (violence, weapon use, vehicular recklessness)
- suicidal tendencies
- The fourth edition of the Preparticipation Physical Evaluation monograph will feature a revamped health questionnaire focused on cardiac health problems that may be exacerbated by physical activity, making additional questions about stimulant use, including energy-drink consumption, important.
- Primary amenorrhea (absence of periods by age 16) or secondary amenorrhea (absence of period for more than three cycles) that may indicate that the athlete is suffering from the female athlete triad.
Efforts To Promote Uniformity Falling Short
On May 13, 2010, the PPE Campaign and Coalition for Youth Sports Health and Safety was launched to promote the widespread adoption and consistent use of an updated preparticipation physical evaluation form (PPE) for pre-competition medical screening of U.S. student-athletes. The coalition includes as founding partners leading medical organizations, sports governing bodies and other groups, including MomsTeam Youth Sports Safety Institute.
A 2014 study (1), however, found that, despite the 2010 endorsement of 6 national medical societies of a single PPE form as part of an effort to standardize the screening process, and nearly unanimous public support for PPE screening by a qualified health care professional before participation in a consistent manner across the country, the medical community is still largely unaware of national sports preparticipation physical evaluation guidelines and only 11% of athletes at US high schools are guaranteed to receive a PPE fully consistent with the national standard.
Further complicating efforts to move towards adoption of the PPE Monograph as a national standard is the recent issuance by the National Athletic Trainers' Association of a position statement (Conley KM, et al. 2014) recommending the use of its own version of the PPE.
Madsen NL, Drezner JA, Salerno JC. The Preparticipation Physical Evaluation: An Analysis of Clinical Practice. Clin J Sports Med. 2014; 24(2):142-149.
PR Newswire. Athletes, physicians urge adoption of new medical screening tool. 2010. http://www.prnewswire.com/news-releases/athletes-physicians- urge-adoption-of-new-medical-screening-tool-93681639.html. Accessed October 18, 2012.
Conley KM, Bolin DJ, Carek PJ, Konin JG, Neal TL, Violette D. National Athletic Trainers' Association Position Statement: Preparticipation Physical Examination and Disqualifying Conditions. J Athl Tr. 2014;49(1):102-120. doi:10.4085/1062-6050-48.6.05.
American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine. Preparticipation physical evaluation. 4th ed. Elk Grove Village, IL; American Academy of Pediatrics, 2010.