Paeds · rheumatology-musculoskeletal-and-sports
Pre-participation sports evaluation
Also known as pre-participation physical evaluation · sports clearance · pre-participation examination · PPE · cardiovascular screening in athletes · athletic pre-screening · sports pre-participation history
A fellowship approach to the pre-participation sports evaluation of the child and adolescent: the AHA 14-element cardiovascular history and examination and its red-flag items, the common causes of sudden cardiac death in the young athlete, the history-versus-ECG screening debate, the AAP paediatric blood pressure thresholds, the female athlete triad and relative energy deficiency in sport, the focused musculoskeletal screen, the clearance decision into cleared, cleared with conditions and restricted pending evaluation, and the written emergency action plan with access to an automated external defibrillator that protects every athlete when the screen misses a latent condition.
On this page
Study tools
Your progress
Saved on this device.
Practise this topic
Target exams
Red flags
- Exertional chest pain, exertional syncope or near-syncope, and excessive dyspnea or fatigue with exercise are the three cardiovascular red flags of the personal history — a single one of them restricts the athlete pending a cardiac work-up, because exertional syncope is sudden cardiac death until proven otherwise
- A close relative with sudden and unexpected death before fifty, or a known familial cardiomyopathy or channelopathy, drives restriction and cardiology referral regardless of how well the athlete feels — the family history identifies the at-risk athlete before the event
- A heart murmur that gets louder on standing or with the Valsalva manoeuvre is the dynamic murmur of hypertrophic cardiomyopathy until proven otherwise — listen supine and standing on every athlete, because a murmur that disappears on standing is reassurance and one that intensifies is a red flag
- An absent or delayed femoral pulse, or a blood pressure that is higher in the arms than the legs, is coarctation of the aorta until proven otherwise — palpate the femoral pulses on every athlete and never attribute a four-limb pressure difference to cuff error
Life stages
Care settings
Clinical exam formats
Board mappings
- Adolescent medicine and developmental health - the pre-participation sports evaluation and safe participation
- Acute presentations - the collapsed athlete and the emergency action plan
- Adolescent and sports medicine - the AHA 14-element cardiovascular screen and the clearance decision
- Acute presentations - exertional syncope and the cardiac red flags of the young athlete
- Chronic care - the female athlete triad and relative energy deficiency in sport
- Adolescent medicine 10-12
- Acute presentations 10-12
- Short Cases
- Long Cases
- 8. Adolescent health - the pre-participation sports evaluation and safe sport
- 9. Cardiology - cardiovascular screening and sudden cardiac death prevention
- 4. Professional skills and knowledge: Patient management
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Clinical
- History
- Communication
- General Pediatrics Content Outline - Adolescent medicine
- General Pediatrics Content Outline - Sports medicine and musculoskeletal disorders
- General Pediatrics Content Outline - Universal Task 4: Management and Treatment
- Patient Care 4: Clinical Reasoning
- Patient Care 5: Patient Management
- Medical Knowledge 1: Cardiovascular and musculoskeletal disorders
- Systems-Based Practice 3: Patient safety and quality improvement
- Medical Expert
- Pediatrics: Adolescent and sports medicine applied domain
A fifteen-year-old basketball player presents for clearance and mentions that he blacked out briefly during a sprint last month, or a fourteen-year-old cross-country runner has a maternal uncle who died suddenly at forty-two, or a sixteen-year-old swimmer is found to have a murmur that gets louder when she stands up. In each, the question is the same — does this history or this finding put the athlete at risk, and what is the right clearance. [1] [5]
Press for the three P's. Pain is exertional chest pain, pressure or tightness. Pass-out is unexplained syncope or near-syncope with exercise. Pathological family is a close relative with sudden death before fifty or a known inherited cardiomyopathy or channelopathy. One positive P restricts the athlete pending a cardiac work-up. [1] [2]
Overview & Definition
A fifteen-year-old walks into clinic week before the season starts, and the question is whether sport is safe. The pre-participation sports evaluation answers that question. It is a systematic medical and musculoskeletal assessment of a child or adolescent before sport, and its goal is to detect the conditions that threaten life or limb and to promote safe participation. It is not a general health check, and it is not a search for every minor ailment that a young person carries. [1] [3]
The evaluation rests on four parts. The medical and cardiovascular history asks the questions that screen for the dangerous conditions. The physical examination listens to the heart, feels the pulses and measures the blood pressure. The musculoskeletal screen checks the limbs and the spine. The clearance decision turns the findings into a safe plan. The history is the most powerful of the four, because most of the conditions that kill young athletes declare themselves in the personal or the family history before they declare themselves on the field. [1] [2]
The fellowship framing turns on a single idea. The screen detects the threat, the clearance promotes safe participation, and the emergency action plan protects the athlete when the screen misses. A candidate who holds all three in mind avoids the two opposite errors — the false reassurance that clears the dangerous athlete, and the over-cautious restriction that bars the healthy one. [3] [10]
References10ShowHide
- [1]Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update. Circulation, 2007.PMID 17353433
- [2]Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, 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). Circulation, 2014.PMID 25223981
- [3]Drezner JA, O'Connor FG, Harmon KG, Fields KB, Asplund CA, Asif IM, et al. AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current evidence, knowledge gaps, recommendations and future directions. Br J Sports Med, 2017.PMID 27660369
- [4]Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA, 2006.PMID 17018804
- [5]Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation, 2009.PMID 19221222
- [6]Pelliccia A, Sharma S. The 2020 ESC Guidelines on Sport Cardiology. Eur Heart J, 2021.PMID 33428717
- [7]Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics, 2017.PMID 28827377
- [8]Mountjoy M, Ackerman KE, Bailey DM, Burke LM, Constantini N, Hackney AC, et al. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med, 2023.PMID 37752011
- [9]Emery CA, van den Berg C, Richmond SA, Palacios-Derflingher L, McKay CD, Doyle-Baker PK, et al. Implementing a junior high school-based programme to reduce sports injuries through neuromuscular training (iSPRINT): a cluster randomised controlled trial. Br J Sports Med, 2020.PMID 31822477
- [10]Schattenkerk J, Kucera K, Peterson DF, Huggins RA, Drezner JA. Socioeconomic factors and outcomes from exercise-related sudden cardiac arrest in high school student-athletes in the USA. Br J Sports Med, 2022.PMID 34716143