Journal Looks at Preseason Exams for Athletes

Newswise — Athletes at all levels—from elementary school to the Olympics—regularly undergo preparticipation evaluation (PPE) to identify medical problems that may pose risks with sport participation. Although the PPE is widely accepted, questions have been raised about its value for identifying problems—and especially for detecting the small percentage of athletes at risk of sudden cardiac death.

What's the best approach to detecting potential problems? How effective are current screening techniques for athletes? These and other questions are addressed in the May/June issue of the Clinical Journal of Sport Medicine, a special thematic issue devoted to points of agreement—and disagreement—regarding the PPE.

In an evidence-based review, Dr. Gordon O. Matheson of Stanford University and colleagues find no firm research data supporting the true effectiveness of the PPE in its current form. There is no standard format for medical evaluation of athletes. Examinations may be performed by various health professionals, some without proper training.

Most importantly, no PPE approach is demonstrably effective in identifying rare congenital heart abnormalities that pose a risk of sudden death in young athletes. Current PPE formats do not consistently address American Heart Association criteria for cardiovascular disease screening. The researchers conclude, "The PPE is required by most schools in America but is not implemented adequately, and no standardized format currently exists."

Dr. James Beckerman and colleagues, also of Stanford, suggest that asking about previous symptoms or family history might be the most effective approach to cardiovascular screening. Electrocardiograms and other tests could be reserved for athletes who answer yes to these questions.

Similarly, a review by Dr. James G. Garrick of University of California-San Francisco finds little evidence that orthopedic screening evaluations reduce the chances of bone and joint injuries. A questionnaire alone, without physical examination, might be just as effective in detecting problems that would place an athlete at risk of injury.

Other issues addressed in the special issue include:· Exercise-induced asthma.— Screening is recommended to deal with the high rates of this potentially dangerous problem in elite-level athletes.· Concussions.—All athletes should undergo preseason testing to guide decisions about return to play should future head injuries occur.· Blood testing for anemia and related problems.—Although few abnormalities are detected, testing is "reasonable" in elite-level athletes.· Health issues in female athletes.—The PPE may provide an important opportunity to detect problems such as eating disorders, menstrual abnormalities, and osteoporosis.· Childhood obesity.—The PPE gives healthcare providers a chance to recognize and intervene in the "obesity epidemic" in school-age children.· A standard approach to the PPE?—An Australian study suggests a format adaptable to different sports and levels of competition. No formal standard evaluation is implemented in Great Britain.· The PPE for college athletes.—The college PPE provides an opportunity to detect and prevent health concerns on and off the athletic field, particularly for female athletes.

"Few athletes are actually denied participation after undergoing a PPE, regardless of the complexity of the examination," Dr. Thomas M. Best of the University of Wisconsin points out in an editorial. Still, the PPE is widely accepted as an important tool for assessing the health and safety of athletes. The current discussion provides "an opportunity for change and consensus" in the detection and management of sport-related health issues, according to Dr. Best. The editors of the Clinical Journal of Sport Medicine hope this special thematic issue will promote further research to define the most effective approaches to the PPE and screening for athletes at all levels.