Sports participation in children and adolescents: The preparticipation physical evaluation
- Albert C Hergenroeder, MD
Albert C Hergenroeder, MD
- Section Editor — Pediatric Sports Medicine; Adolescent Sports Medicine
- Professor & Chief of Pediatrics, Adolescent Medicine and Sports Medicine
- Baylor College of Medicine
- Section Editors
- Joseph Chorley, MD
Joseph Chorley, MD
- Section Editor — Pediatric Sports Medicine; Adolescent Sports Medicine
- Associate Professor of Pediatrics, Adolescent Medicine, and Sports Medicine
- Baylor College of Medicine
- John K Triedman, MD
John K Triedman, MD
- Section Editor — Pediatric Cardiology
- Professor of Pediatrics
- Harvard Medical School
Approximately 30 million children and adolescents participate in organized sports in the United States. The standard of care is that these athletes have a preparticipation physical evaluation (PPE) before the season begins .
The PPE in children and adolescents is reviewed here. Broader guidelines for preventive care in adolescents are presented separately. (See "Guidelines for adolescent preventive services".)
Additional aspects of sports participation in children and adolescents are presented separately:
●Benefits of physical activity and strength training (see "Physical activity and strength training in children and adolescents: An overview")
●Sports-related concussion (see "Sideline evaluation of concussion" and "Concussion in children and adolescents: Clinical manifestations and diagnosis" and "Concussion in children and adolescents: Management")
Subscribers log in hereTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: Jul 2017. | This topic last updated: May 11, 2016.References
- American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Me. Preparticipation Physical Evaluation, 4th ed, Bernhardt D, Roberts W (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2010.
- Maron BJ, Levine BD, Washington RL, et al. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 2: Preparticipation Screening for Cardiovascular Disease in Competitive Athletes: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation 2015; 132:e267.
- Roberts WO, Löllgen H, Matheson GO, et al. Advancing the preparticipation physical evaluation (PPE): an ACSM and FIMS joint consensus statement. Curr Sports Med Rep 2014; 13:395.
- Bergman AB, Stamm SJ. The morbidity of cardiac nondisease in schoolchildren. N Engl J Med 1967; 276:1008.
- 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.
- Black JL, Nader PR, Broyles SL, Nelson JA. A national survey on pediatric training and activities in school health. J Sch Health 1991; 61:245.
- Stirling JM, Landry GL. Sports medicine training during pediatric residency. Arch Pediatr Adolesc Med 1996; 150:211.
- Campbell RM, Berger S. Preventing pediatric sudden cardiac death: where do we start? Pediatrics 2006; 118:802.
- Carek PJ, Mainous AG 3rd. A thorough yet efficient exam identifies most problems in school athletes. J Fam Pract 2003; 52:127.
- Garrick JG. Preparticipation orthopedic screening evaluation. Clin J Sport Med 2004; 14:123.
- Maron BJ, Thompson PD, Ackerman MJ, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 2007; 115:1643.
- Iverson GL, Silverberg ND, Mannix R, et al. Factors Associated With Concussion-like Symptom Reporting in High School Athletes. JAMA Pediatr 2015; 169:1132.
- Rupp NT, Guill MF, Brudno DS. Unrecognized exercise-induced bronchospasm in adolescent athletes. Am J Dis Child 1992; 146:941.
- Hallstrand TS, Curtis JR, Koepsell TD, et al. Effectiveness of screening examinations to detect unrecognized exercise-induced bronchoconstriction. J Pediatr 2002; 141:343.
- Maron BJ, Friedman RA, Kligfield P, et al. Assessment of the 12-lead ECG as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 Years of Age): a scientific statement from the American Heart Association and the American College of Cardiology. Circulation 2014; 130:1303.
- Oppliger RA, Harms RD, Herrmann DE, et al. The Wisconsin wrestling minimum weight project: a model for weight control among high school wrestlers. Med Sci Sports Exerc 1995; 27:1220.
- Oppliger RA, Case HS, Horswill CA, et al. American College of Sports Medicine position stand. Weight loss in wrestlers. Med Sci Sports Exerc 1996; 28:ix.
- Thorland WG, Tipton CM, Lohman TG, et al. Midwest wrestling study: prediction of minimal weight for high school wrestlers. Med Sci Sports Exerc 1991; 23:1102.
- Grinsell MM, Butz K, Gurka MJ, et al. Sport-related kidney injury among high school athletes. Pediatrics 2012; 130:e40.
- Rice SG, American Academy of Pediatrics Council on Sports Medicine and Fitness. Medical conditions affecting sports participation. Pediatrics 2008; 121:841.
- Johnson B, Christensen C, Dirusso S, et al. A need for reevaluation of sports participation recommendations for children with a solitary kidney. J Urol 2005; 174:686.
- Grinsell MM, Showalter S, Gordon KA, Norwood VF. Single kidney and sports participation: perception versus reality. Pediatrics 2006; 118:1019.
- Knapik JJ, Bauman CL, Jones BH, et al. Preseason strength and flexibility imbalances associated with athletic injuries in female collegiate athletes. Am J Sports Med 1991; 19:76.
- Chaitman BR. An electrocardiogram should not be included in routine preparticipation screening of young athletes. Circulation 2007; 116:2610.
- Myerburg RJ, Vetter VL. Electrocardiograms should be included in preparticipation screening of athletes. Circulation 2007; 116:2616.
- Corrado D, Thiene G. Protagonist: routine screening of all athletes prior to participation in competitive sports should be mandatory to prevent sudden cardiac death. Heart Rhythm 2007; 4:520.
- Viskin S. Antagonist: routine screening of all athletes prior to participation in competitive sports should be mandatory to prevent sudden cardiac death. Heart Rhythm 2007; 4:525.
- Sharma S, Estes NA 3rd, Vetter VL, Corrado D. Clinical decisions. Cardiac screening before participation in sports. N Engl J Med 2013; 369:2049.
- Maron BJ, Winkel BG, Tfelt-Hansen J. Perspectives on cardiovascular screening. JAMA 2015; 313:31.
- Niebauer J, Corrado D, Pelliccia A. Cardiovascular screening for young athletes. JAMA 2015; 313:1674.
- Harmon KG, Drezner JA. Cardiovascular screening for young athletes. JAMA 2015; 313:1673.
- Maron BJ, Zipes DP, Kovacs RJ, American Heart Association Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Preamble, Principles, and General Considerations: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation 2015; 132:e256.
- McCambridge TM, Benjamin HJ, Brenner JS, et al. Athletic participation by children and adolescents who have systemic hypertension. Pediatrics 2010; 125:1287.
- National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114:555.
- Centers for Disease Control and Prevention (CDC). Sports-related injuries among high school athletes--United States, 2005-06 school year. MMWR Morb Mortal Wkly Rep 2006; 55:1037.
- Brooks MA, Schiff MA, Rivara FP. Identifying previous sports injury among high school athletes. Clin Pediatr (Phila) 2009; 48:548.
- Jones BH, Cowan DN, Tomlinson JP, et al. Epidemiology of injuries associated with physical training among young men in the army. Med Sci Sports Exerc 1993; 25:197.
- Schmidt-Olsen S, Jørgensen U, Kaalund S, Sørensen J. Injuries among young soccer players. Am J Sports Med 1991; 19:273.
- Maron BJ, Doerer JJ, Haas TS, et al. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation 2009; 119:1085.
- De Souza MJ, Nattiv A, Joy E, et al. 2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad: 1st International Conference held in San Francisco, CA, May 2012, and 2nd International Conference held in Indianapolis, IN, May 2013. Clin J Sport Med 2014; 24:96.
- Hergenroeder AC, De Souza MJ, Anding RH. The Female Athlete Triad: Energy Deficiency, Physiologic Consequences, and Treatment. Adolesc Med State Art Rev 2015; 26:116.
- Mitten MJ, Zipes DP, Maron BJ, et al. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 15: Legal Aspects of Medical Eligibility and Disqualification Recommendations: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation 2015; 132:e346.
- Consensus guidelines
- Goals of the PPE
- Unnecessary restriction
- PRACTICAL CONSIDERATIONS
- COMPONENTS OF THE EVALUATION
- Evaluation forms
- Medical history
- - Injury history
- - Cardiovascular history
- - Review of symptoms
- Musculoskeletal examination
- Cardiovascular examination
- Targeted PE
- LABORATORY TESTING
- STRENGTH EVALUATION
- NONINVASIVE CARDIOVASCULAR TESTING
- SPORTS PARTICIPATION
- Restrictions to participation
- Specific conditions
- Legal issues
- SUMMARY AND RECOMMENDATIONS