1. Preparticipation physical evaluations (PPE) were required for students to engage in sports programs in 49 states of the country, but only 19 states (37%) required use of the most updated evaluation form.
2. On average, states addressed only 58% or 7 of the 12 items on the updated physical evaluation form in assessing cardiovascular risk.
Study Rundown: In order to increase safe participation in sports and to decrease events of sudden cardiac death, it is currently recommended that high school athletes complete a PPE before engaging in school sport programs. The Preparticipation Physical Evaluation-Fourth Edition (PPE-4) form is considered the standard among many organizations; however, use of this evaluation guideline is not a national requirement. The purpose of this study was to evaluate current PPE policies in the 50 United States and Washington D.C., as well as adherence to cardiovascular screening in the PPE-4. Researchers found that sports physicals were required in almost all states, but the updated form was required in less than half of these locations. On average, states addressed 7 out of 12 items required by the PPE-4 form for personal and family history screening for cardiovascular risk. This study may be limited as only public documents were available for assessment, and current policies may have since been improved or changed. The importance of screening and the variability nationwide indicates the importance of establishing more standard practices and may encourage providers to use the most current PPE form in order to facilitate safe sports experiences.
Relevant Reading: Incidence of sudden cardiac death in athletes
Study Author, Dr. Shane V. Caswell, PhD, ATC, CSCS, talks to 2 Minute Medicine: Professor of Athletic Training Education Program, Executive Director of Sports Medicine Assessment Research & Testing Laboratory, George Mason University.
“The pre-participation physical evaluation (PPE) plays an important role in ensuring safe participation in sport. Our findings demonstrate that many states have been slow to adopt best practices and further reiterates a need for nationwide PPE standardization. Ultimately, our findings also serve as reminder that the implementation of best practices is an on-going process not a singular event. Healthcare providers and policy makers must have an understanding of the best available evidence and work collaboratively to see that it is properly implemented, rigorously evaluated, and improved upon in a timely fashion.”
In-Depth [cross-sectional study]: Researchers obtained the current PPE forms from state (All 50 states, including Washington D.C) athletic association websites during August 2014. Forms were reviewed independently by 2 investigators. All content was compared to the requirements established by the PPE-4 form. Each form was also evaluated for content pertaining to cardiovascular history and physical evaluation and whether or not all 12 recommended personal and family history items from the PPE-4 were addressed. PPEs were required in 98% of all locations. A specific PPE form was required in 27 states (53%), and the PPE-4 form was required in 19 of those states (37%). A total of 27 (53%) recommended or required the use of an outdated form. On average, states addressed 7 of the 12 personal and family history items recommended on the PPE-4 for cardiovascular screening.
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