State-Specific Differences in School Sports Preparticipation Physical Evaluation Policies

Abstract

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or recommended use of the PPE-4 form or a modified version of it, and 27 states (53%) required or recommended use of outdated or unidentifiable forms.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.

AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current evidence, knowledge gaps, recommendations and future directions

“…Recent studies suggest that less than half of primary care physicians are aware of the cardiovascular screening recommendations from the American Heart Association or the PPE Monograph 73 74. In a survey of cardiovascular screening practices at National Collegiate Athletic Association Division I universities, 92% of responding universities did not use PPE forms that fully meet the American Heart Association recommendations for cardiovascular screening,75 and, in 2014, only 43% of state high school athletic associations require forms that fully address all of the PPE Monograph (4th edition) personal and family history cardiovascular screening recommendations 76…”

High Prevalence of Obesity and High Blood Pressure in Urban Student-Athletes

“…In the US, 49 of the 50 states currently require some version of the PPE to be performed. 6 Previous focus has been put into using the PPE to address sudden cardiac arrest and sudden cardiac death. Although this is a tragic event, it is rare.…”

Increasing Primary Care Follow-up after Preparticipation Physical Evaluations

“…However, in 2015, only 27 states designate which form to use, and 23 states used a form that supports all of the recommendations in the PPE-4 monograph. 8 There is also a significant variation regarding which medical providers can conduct PPEs. An analysis by Caswell et al 8 determined that 74% of states allow a nonphysician to perform the examination.…”

“… 8 There is also a significant variation regarding which medical providers can conduct PPEs. An analysis by Caswell et al 8 determined that 74% of states allow a nonphysician to perform the examination. Similarly, a list of competency in cardiovascular screening or sports medicine is not required by any state, and knowledge likely varies widely across providers.…”

“…Similarly, a list of competency in cardiovascular screening or sports medicine is not required by any state, and knowledge likely varies widely across providers. 8 Because of the considerable variation, it has been challenging to study the efficacy of PPEs in preventing injuries and sudden death. 9 – 15 A uniform process for PPEs at the national, state, and local level would facilitate further research and outcome measures.…”