National Athletic Trainers' Association Position Statement: Preparticipation Physical Examinations and Disqualifying Conditions

Conley, Kevin; Bolin, Delmas J.; Carek, Peter J.; Konin, Jeff G.; Neal, Timothy; Violette, Danielle

doi:10.4085/1062-6050-48.6.05

Cited by 67 publications

(59 citation statements)

References 115 publications

(161 reference statements)

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“…However, the assessment of HR dynamics is possible via the ECG. The method of ECG is also on the list of recommended screening methods by the American Coaching Association (Conley et al, 2014). The use of the method of ECG control over functional state of wrestlers is also admitted by some Russian specialists.…”

Section: Methodsmentioning

confidence: 99%

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Osipov¹,

Kudryavtsev²,

Kuzmin³

et al. 2016

JPES

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Abstract:The aim of this paper is to find out effective, informative and available monitoring techniques and ways of assessment of sambo wrestlers' functional readiness for training and competitive activity. Recent research based on the standard medical examination data suggests that many sambo wrestlers demonstrate unsatisfying types of cardiovascular response to exercise. The paper provides the results of a comparative analysis concerning the efficiency of utilization of two methods that allow controlling the functional state of sportsmen in the training for sambo wrestlers. These two methods include the assessment of heart rate recovery dynamics and ECG recording during training. As it was revealed, both techniques allow maintaining athletes' physical health. However, the ECG recording method, developed by Professor Zavyalov, seems to work better to increase the level of sambo wrestlers' functional readiness for intensive training and competitive activity. Sambo wrestlers who underwent ECG recording have demonstrated significantly less recovery interval after physical exertion (p<0.05), this being one of the key criteria of the level of sportsmen's functional readiness for high performance achievement.

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Section: Methodsmentioning

confidence: 99%

Untitled

Osipov¹,

Kudryavtsev²,

Kuzmin³

et al. 2016

JPES

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“…1,7 Unfortunately, 75% of the deaths during National Collegiate Athletic Association (NCAA) sport participation resulted from a cardiovascular condition. 8 Consequently, the current recommendations for preparticipation examinations and disqualification of athletes with cardiovascular abnormalities are not preventing sudden death.…”

Section: Commentarymentioning

confidence: 99%

“…8 Consequently, the current recommendations for preparticipation examinations and disqualification of athletes with cardiovascular abnormalities are not preventing sudden death. Based on literature from the 1980s, the NATA position statement on preparticipation examinations 7 noted that the annual sport physical was the only source of a medical evaluation for 30% to 88% of secondary school athletes. We must also reflect on the current structure of preparticipation examinations in sports medicine that rely heavily upon recall of the student and parent or legal guardian.…”

Section: Commentarymentioning

confidence: 99%

Optimal Screening Methods to Detect Cardiac Disorders in Athletes: An Evidence-Based Review

Winkelmann

Crossway

2017

Journal of Athletic Training

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Reference/Citation: Harmon KG, Zigman M, Drezner JA. The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: a systematic review/meta-analysis. J Electrocardiol. 2015;48(3):329-338.Clinical Question: Which screening method should be considered best practice to detect potentially lethal cardiac disorders during the preparticipation physical examination (PE) of athletes?Data Sources: The authors completed a comprehensive literature search of MEDLINE, CINAHL, Cochrane Library, Embase, Physiotherapy Evidence Database (PEDro), and SPORTDiscus from January 1996 to November 2014. The following key words were used individually and in combination: ECG, athlete, screening, pre-participation, history, and physical. A manual review of reference lists and key journals was performed to identify additional studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this review.Study Selection: Studies selected for this analysis involved (1) outcomes of cardiovascular screening in athletes using the history, PE, and electrocardiogram (ECG); (2) history questions and PE based on the American Heart Association recommendations and guidelines; and (3) ECGs interpreted following modern standards. The exclusion criteria were (1) articles not in English, (2) conference abstracts, and (3) clinical commentary articles. Study quality was assessed on a 7-point scale for risk of bias; a score of 7 indicated the highest quality. Articles with potential bias were excluded.Data Extraction: Data included number and sex of participants, number of true-and false-positives and negatives, type of ECG criteria used, number of cardiac abnormalities, and specific cardiac conditions. The sensitivity, specificity, falsepositive rate, and positive predictive value of each screening tool were calculated and summarized using a bivariate randomeffects meta-analysis model.Main Results: Fifteen articles reporting on 47 137 athletes were fully reviewed. The overall quality of the 15 articles ranged from 5 to 7 on the 7-item assessment scale (ie, participant selection criteria, representative sample, prospective data with at least 1 positive finding, modern ECG criteria used for screening, cardiovascular screening history and PE per American Heart Association guidelines, individual test outcomes reported, and abnormal screening findings evaluated by appropriate diagnostic testing). The athletes (66% males and 34% females) were ethnically and racially diverse, were from several countries, and ranged in age from 5 to 39 years. The sensitivity and specificity of the screening methods were, respectively, ECG, 94% and 93%; history, 20% and 94%; and PE, 9% and 97%. The overall false-positive rate for ECG (6%) was less than that for history (8%) or PE (10%). The positive likelihood ratios of each screening method were 14.8 for ECG, 3.22 for history, and 2.93 for PE. The negative likelihood ratios were 0.055 for ECG, 0.85 for history, and 0.93 f...

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“…A proposed benefit of a PPE conducted by a sole medical provider, ideally in the medical home, is the assumption that the examiner is knowledgeable about his or her patient's health history and qualified to screen for cardiovascular conditions. 5,15,30 However, upon reviewing the educational requirements described by the accrediting agencies, we were unable to find a listing of specific cardiovascular competencies in their literature, and we found no information available regarding the availability of or requirements for specialized training for these nonphysician professionals in recognizing cardiovascular conditions. We are uncertain of the underlying medical reasons for permitting nonphysician professionals to conduct the PPE.…”

Section: Figurementioning

confidence: 99%

“…Many conditions requiring further evaluation can be identified by taking a systematic history during the PPE. 6,30 A 2009 study by Rausch et al 10 reported that 85% of state PPE forms reflected the outdated 1996 AHA guidelines for cardiovascular screening. In addition, they reported that only 8 (16%) of the 51 state forms completely addressed the personal and family history cardiac screening questions specified in the PPE-3.…”

Section: Figurementioning

confidence: 99%

State-Specific Differences in School Sports Preparticipation Physical Evaluation Policies

et al. 2015

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OBJECTIVE: This study evaluated the current preparticipation physical evaluation (PPE) administrative policies and cardiovascular screening content of all 50 states and Washington, DC.METHODS: PPE policies, documents, and forms from all 50 states and Washington, DC, were compared with the preparticipation physical evaluation-fourth edition (PPE-4) consensus recommendations. All electronic documents were publicly available and obtained from state interscholastic athletic associations.RESULTS: Fifty (98%) states required a PPE before participation. Most states (53%, n = 27) required a specific PPE form, whereas 24% (n = 12) of states recommended a specific form. Twenty-three states (45%) required or recommended use of the PPE-4 form or a modified version of it, and 27 states (53%) required or recommended use of outdated or unidentifiable forms. Ten states (20%) had not revised their PPE forms in .5 years. States permitted 9 different health care providers to administer PPEs. Only 22 states (43%) addressed all 12 of the PPE-4 personal and family history cardiovascular screening items, and 2 states (4%) addressed between 8 and 11 items. For the remaining 26 states, most (29%) addressed #3 screening items. CONCLUSIONS:Our results show that inconsistencies in PPE policies exist nationwide. Most states have been slow to adopt PPE-4 recommendations and do not adequately address the personal and family cardiovascular history questions. Findings suggest a need for PPE standardization nationwide and adoption of an electronic PPE process. This approach would enable creation of a national database and benefit the public by facilitating a more evidenced PPE.WHAT'S KNOWN ON THIS SUBJECT: Preparticipation physical evaluations (PPEs) are considered necessary for a high standard of care for US scholastic athletes. However, important questions remain regarding consistency of implementation and content of cardiovascular screening practices among states. WHAT THIS STUDY ADDS:Our results show that PPE policies are variable among US states, and adoption of current PPE-4 best practices is slow, demonstrating the need for nationwide PPE standardization.

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National Athletic Trainers' Association Position Statement: Preparticipation Physical Examinations and Disqualifying Conditions

Cited by 67 publications

References 115 publications

Untitled

Untitled

Optimal Screening Methods to Detect Cardiac Disorders in Athletes: An Evidence-Based Review

State-Specific Differences in School Sports Preparticipation Physical Evaluation Policies

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