NATA Position Statement
Preparticipation Physical Examination
and Disqualifying Conditions
2014
Warm up Questions
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Do you require PPE’s or “perform the PPE”?
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Who is the Medical Professional signature?
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General Practice Physician (DO or MD)
Orthopedic Surgeon
PA, Nurse, Chiropractor
What is the purpose of the PPE?
Objective of the Position Statement
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To present athletic trainers with
recommendations for the content and
administration of the Preparticipation Physical
Examination (PPE) as well as considerations
for determine safe participation in sports and
identifying disqualifying conditions.
Interesting Facts
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2010-2011 = 7.6 million High School Students
used a standardized PPE, p102
A complete Medical History identifies
approximately 75% of problems that affect initial
athletic participation. p106
SCD occurs in about 0.5 per 100,000 high school
athletes per academic year. p107
EIB in elite athletes, 6-21%, so screen. p113
30% of young adults (18-25) had the highest level
of Mental Health Illness, p115
Background
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How long have we been doing PPEs?
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Are they standardized?
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Example: High School State Association
Why do PPE’s?
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40 years according to the NATA.
NCAA did not mandate PPE’s for all athletes until
recently.
Recommendations – 29 specific statements
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Each “graded”, SORT – Strength of
Recommendation Taxonomy. A, B, C
SORT
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“A” – Recommendation based on consistent
and good quality experimental evidence
(morbidity, mortality, exercise and cognitive
performance, physiologic responses)
“B” – Recommendation based on inconsistent
or limited quality Experimental Evidence.
“C” – Recommendation based on consensus;
usual practice, opinion, disease-oriented
evidence, case studies of dx, tx, prevention ,
or screening.
American Medical Association Group on
Science and Technology
1.
2.
To identify those athletes who have medical
conditions that place them at substantial risk
for injury or sudden death and to disqualify
them from participation or ensure they
receive adequate medical treatment.
Do not disqualify athletes unless there is a
compelling medical reason.
Only “A” Recommendation
Orthopedic Screening
9. The musculoskeletal hx screening and
examination can be combined for
asymptomatic Athletes with no previous
injuries. If player has either a previous injury
or signs . . The relevant elements of a site
specific examination should be performed.
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Sections of Recommendations
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Medical and Family History
Physical Examination
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General Health Screening
Cardiovascular Screening
Neurologic Screening
Orthopaedic Screening
General Medical Screening
Medical Use
Nutritional Assessment
Heat and Hydration Related Illness Risk Factors
Mental Health Considerations
Table 2 –The 12-Element American Heart
Association Recommendations for PPE
Heart
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Medical Hx
PersonalX
1. Exertional chest pain/discomfort
2. Unexplained syncope/near syncope
3. Excessive exertional and unexplained
dyspnea/fatigue, associated with exercise
4. Prior recognition of a heart murmur
5. Elevated system Blood Pressure
Table 2 Cont.
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Family Hx
6. Premature death before 50 y due to heart disease
in >1
7. Disability from heart disease in a close relative
age < 50y
8. Specific knowledge of certain cardiac conditions
in family members, examples listed page 104
Table 2 Cont.
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Physician Examination
9. Heart Murmur
10. Femoral pulses to exclude aortic coarctation
11. Physical stigmata of Marfan Syndrome
12. Brachial Artery Blood pressure (sitting position)
taken in both arms.
Other Tables of Note
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Table 3 - Questions Regarding Presence of
Cardiovascular Risk Factors
Table 4 - The 90-Second Musculoskeletal Screening
Examination
Table 5 – Conditions Associated with Abnormal Arterial
Pulse Waves
Table 6 – Classification of Sports According to
Cardiovascular Demands
Table 7 – Spine Condition Participation Recommendations
Table 8 – Classification of Sports by Contact
Table 9 – Mental Health-Related Survey
Table 9 Mental Health Survey (Yes or No)
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I often have trouble sleeping.
I wish I had more energy most days of the week.
I think about things over and over.
I feel anxious and nervous much of time.
I often fell sad or depressed.
I struggle with being confident.
I don’t feel hopeful about the future.
I have a hard time managing my emotions.
(Frustration, anger, impatience)
I have feelings of hurting myself or others.
Recommendations continued
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Administration of PPE #22 - 27
Determining Clearance # 28-29
29. Team Physicians and Institutions have the
legal right to restrict an individual from
participating in athletics, provided the
decision is individualized, reasonably make,
and based on competent medical evidence.
Let’s Stop and Discuss
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How to you do it?
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Stations vs Individuals?
In house vs Community Medical Professionals?
What do you do that is GREAT?
Anything you want to improve?
Red Flags< how does your referral process
work?
Do you address all “areas” including mental
health?
The Evidence: Background and Literature
Review
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“Evidence to support the above-referenced
recommendations and the best practices in
developing and delivering a comprehensive
PPE follows.
Good read! Pages 106 – 115.
Laboratory and Diagnostic Screening
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Anemia
Sickle Cell Trait
Diabetes Mellitus
Lipid Disorders
Exercised-Induced Bronchospasm (EIB)
Medication use
Nutritional Assessment
Heat-Related Illness and Hydration Risk
Factors
Mental Health Consideration
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Medication use
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Nutritional Assessment
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See previous NATA Position Statement for
screening.
Heat-Related Illness and Hydration Risk
Factors
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Document everything (supplements/medications)
and justify including energy drinks.
See precious NATA Position Statement
Mental Health Consideration
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1 in 5 teens in the US suffer from a mental
disorder sever enough to affect daily life. (2010)
REFER to a Psychologist!
PPE Administration
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FERPA and HIPPA
Timing
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Instrument
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4-6 weeks prior to pre-season practice
The American Academy of Pediatrics template
Method
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Athlete’s Personnel Physician or Larger Scale
Screening
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Personnel
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Physician (Doctor of Medicine or Osteopathy) with
clinical training.
Determination of Clearance
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Occasionally, an abnormality or condition is found
that may limit an athlete’s participation or
predispose them to further injury.
A specific risk analysis to provide guidance has
not been developed.
Determination of Clearance
1.
2.
3.
Does the condition pose an unacceptable
risk or place the athlete at increased risk?
Does the condition place other participants
at risk for injury?
Can the athlete safely participate with
treatment (eg, medication, bracing)?
Determination of Clearance cont.
4.
5.
Can limited participation be allowed while
Tx is being completed?
If clearance is denied for certain sports
categories, which activities can the athlete
safely participate?
Discussion and Questions
Take Away Points