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The preparticipation athletic evaluation
1Department of Family Medicine, Finch University of Health Sciences/Chicago Medical School, North Chicago, Illinois 60064, USA.
Insights
A thorough medical history and targeted physical exam are key for preparticipation athletic evaluations. Screening tests are not routinely recommended unless specific risk factors or symptoms are present.
Area of Science:
- Sports Medicine
- Cardiology
- Preventive Medicine
Background:
- Preparticipation athletic evaluations are crucial for identifying conditions that may pose risks during sports.
- Cardiovascular diseases and sudden cardiac death are significant concerns in young athletes.
Purpose of the Study:
- To outline the essential components of a preparticipation athletic evaluation.
- To identify conditions that may warrant exclusion or limitation of athletic participation.
Main Methods:
- Comprehensive medical history including personal/family cardiovascular, neurologic, and musculoskeletal issues.
- Focused physical examination emphasizing cardiac auscultation with provocative maneuvers.
- Evaluation of spine and extremities.
Main Results:
- Hypertrophic cardiomyopathy is the leading cause of sudden death in young male athletes.
- Screening tests like ECG or stress tests are not indicated without symptoms or risk factors.
- Approximately 1% of screened athletes are disqualified.
Conclusions:
- A detailed medical history and focused physical exam are the cornerstones of preparticipation screening.
- Routine use of non-symptomatic screening tests is not supported.
- Specific conditions necessitate disqualification or modification of athletic participation.
Abstract:
A comprehensive medical history that includes questions about a personal and family history of cardiovascular disease is the most important initial component of the preparticipation athletic evaluation. Additional questions should focus on any history of neurologic or musculoskeletal problems. A limited physical examination should emphasize cardiac auscultation with provocative maneuvers to screen for hypertrophic cardiomyopathy. This condition is the most common cause of sudden death in young male athletes. Other components of the physical examination include an evaluation of the spine and extremities. Screening tests such as electrocardiography, treadmill stress testing and urinalysis are not indicated in the absence of symptoms or a significant history of risk factors. Specific conditions that would exclude or limit athletic participation include hypertrophic cardiomyopathy, long QT interval syndrome, concussion, significant knee injury, sickle cell disease and uncontrolled seizures. Overall, about 1 percent of athletes who are screened are completely disqualified from sports participation.