States' Preparticipation Physical Evaluations Vary Widely

Susan London

December 22, 2014

States vary widely in their policies regarding preparticipation physical evaluations (PPEs) for high school students, aimed at minimizing sudden cardiac death and other serious injuries, according to a study published online December 22 in Pediatrics. In addition, only a minority of states have adopted consensus recommendations that outline best practices for this screening.

The study's results "show that nationwide inconsistencies in PPE policies continue to exist within and between all 50 states and Washington, DC," write Shane V. Caswell, PhD, ATC, from the Sports Medicine Assessment, Research & Testing Laboratory, George Mason University, Manassas, Virginia, and colleagues.

"Our findings suggest the need for a nationwide standardized PPE form and the use of an electronic PPE process to improve adherence and develop a nationwide database. Such an approach would benefit the public by facilitating the creation of a robust and uniform nationwide data resource to evaluate and develop an evidenced PPE and help safeguard participation in sport," they maintain.

The investigators identified PPE policies, documents, and forms from public high school state athletic associations that were sanctioned by the National Federation of State High School Associations in all 50 states and Washington, DC, through August 2014. They then compared these items against the Preparticipation Physical Evaluation, Fourth Edition (PPE-4), consensus recommendations, which outline best practices and strongly endorse a standardized approach to these evaluations.

Nearly all states/jurisdictions (50, or 98%) required a PPE before students participated in scholastic sports; Vermont was the exception, permitting individual school systems to direct these decisions. A slight majority of states, 53% (n =27), required a specific PPE form, and 24% (n =12) recommended a specific form.

However, just 45% (n =23) of states either required or recommended use of the PPE-4 form or a modified version of it, and 53% (n = 27) required or recommended use of outdated or unidentifiable forms. Twenty percent (n = 10) of states had not revised their forms in more than 5 years.

States permitted nine different healthcare professionals to perform PPEs. These included nonphysicians such as nurses, physical therapists, and practitioners of complementary and alternative medicine.

On average, states completely addressed 7 of the 12 personal and family history cardiovascular screening items recommended in the PPE-4; the item most commonly not addressed concerned a family history of unexplained fainting, unexplained seizures, or near drowning. Less than half (43%; n = 22) of states addressed all 12 items, and most of the remaining states addressed 3 or fewer items.

Although 80% (n = 41) of states required that students undergo a PPE every year before participation, 14% (n = 7) required it every other year, and a single state (South Dakota) required it less frequently; another two states did not specify frequency.

Supported in part by nonrestrictive funding from the Potomac Health Foundation. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online December 22, 2014. Abstract


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