National Athletic Trainers' Association Position Statement: Preparticipation Physical Examinations and Disqualifying Conditions

Objective

To present athletic trainers with recommendations for the content and administration of the preparticipation physical examination (PPE) as well as considerations for determining safe participation in sports and identifying disqualifying conditions.

Background

Preparticipation physical examinations have been used routinely for nearly 40 years. However, considerable debate exists as to their efficacy due to the lack of standardization in the process and the lack of conformity in the information that is gathered. With the continuing rise in sports participation at all levels and the growing number of reported cases of sudden death in organized athletics, the sports medicine community should consider adopting a standardized process for conducting the PPE to protect all parties.

Recommendations

Recommendations are provided to equip the sports medicine community with the tools necessary to conduct the PPE as effectively and efficiently as possible using available scientific evidence and best practices. In addition, the recommendations will help clinicians identify those conditions that may threaten the health and safety of participants in organized sports, may require further evaluation and intervention, or may result in potential disqualification.Key Words: medical history, family history, sudden cardiac death, concussion, sickle cell trait, diabetes, heat illness, hydrationParticipation in organized US athletics continues to rise. During the 2010–2011 academic year, more than 7.6 million high school students took part in organized interscholastic sports, compared with 7.1 million in 2005–2006.¹ Similarly, an additional 444 077 National Collegiate Athletic Association student–athletes participated in intercollegiate athletics in 2010–2011, compared with 393 509 in 2005–2006.² This growth in participation has led to a concomitant rise in sudden death. Most sudden deaths have been attributed to congenital or acquired cardiovascular malformations involving male football and basketball players.^3–5 Other causes of sudden death include heat stroke, cerebral aneurysm, asthma, commotio cordis, and sickle cell trait.^4,5 As sports participation continues to increase and catastrophic death in athletes receives more attention, the medical community should consider adopting a standardized preparticipation examination (PPE) instrument that, at a minimum and to the extent possible, sets out to ensure a safe playing environment for all and to identify those conditions that might predispose an athlete to injury or sudden death.For nearly 4 decades, PPE screening has been used routinely in an attempt to identify those conditions that may place an athlete at increased risk and affect safe participation in organized sports. Few would empirically argue the potential benefits of this practice, yet considerable debate exists as to the current efficacy of the PPE, given the significant disparities that presently characterize the examination and the information gathered. Over time, the PPE has become an integral component of athletics and sports medicine programs; however, the lack of standardization in the process has created confusion. In addition, the failure to adequately define the primary objectives of the PPE has led to the consensus that, in its current form, the PPE does not address the ultimate goal of protecting the health and safety of the player.The American Medical Association Group on Science and Technology⁶ has asserted that every physician has 2 responsibilities to an athlete during the PPE: “(1) 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 before participation and (2) to not disqualify athletes unless there is a compelling medical reason.” As the PPE has evolved over the years, it has become increasingly difficult to meet these standards given the many objectives that have been proposed for the screening instrument. Originally, the primary objectives of the PPE were to (1) detect life-threatening or disabling conditions, (2) identify those conditions that predispose the athlete to injury or disability, and (3) address legal and insurance requirements.^7,8 Today, however, those entities charged with developing and revising the PPE (eg, state high school athletic associations, medical associations, state education departments, state health departments, legislators)⁹ often have different missions, and as a result, they have sought to influence the makeup of the PPE to address their specific interests. This has led to the identification of a number of secondary objectives, including but not limited to documenting athletic eligibility, obtaining parental consent for participation and emergency treatment, and improving athlete performance.⁹ Most notably, the PPE represents the sole source of medical evaluation for 30% to 88% of children and adolescents annually^10,11 and an opportunity to identify conditions that, although not necessarily related to or requiring restriction from athletic participation, nonetheless call for additional follow-up.⁹ Some authors¹² have advocated this practice to evaluate the general health of the athlete and to provide an opening to discuss high-risk behaviors, preventive care measures, and nonathletic concerns. Others oppose this view, stating that the PPE “should not be the sole component of health care for athletes”⁶ and that the PPE can only be effective if the goals remain specific and properly directed toward the demands of sport participation.^6,13     

A non-invasive oral rinse assay predicts bone marrow engraftment and 6 months prognosis following allogeneic hematopoietic stem cell transplantation

J Oral Pathol Med (2012) 41 : 165–170 Background: We have previously shown in a pediatric Hematopoietic stem cell transplant (HSCT) population that a non‐invasive oral rinse can be used to monitor engraftment, neutrophil tissue delivery and susceptibility to infection post‐HSCT. Methods: Using the same oral rinse protocol, we studied neutrophil tissue delivery kinetics and its relationship to clinical parameters and outcomes following HSCT in 29 adult patients. Oral neutrophil counts were compared to circulating neutrophil levels, oral mucositis scores and patient health status at 6 months post‐HSCT. Results: Neutrophils were detected on average 8.4 ± 3.4 SD days earlier in the oral tissues than in the blood circulation, enabling us to confirm successful engraftment more than one week earlier than when using blood neutrophil counts alone. As well, in this population the time‐span between oral engraftment (OE) and blood engraftment (BE) was a consistent predictor of treatment outcome at 6 months following HSCT where a BE–OE of <6 days resulted in 100% of patients having a negative outcome. Conclusion: We conclude that monitoring the timing of neutrophil delivery to the oral tissues with a non‐invasive oral rinse has the potential to allow the physician to identify those patients who are at a high risk of HSCT failure within just a few weeks of the initiation of treatment.     

Improving quality of life using removable and fixed implant prostheses

Removable and fixed implant-retained prostheses can greatly enhance patients' quality of life, improving their speech, appearance, and ability to eat and otherwise function normally. Yet patients may resist this type of treatment due to barriers, including cost, fear, and lengthy treatment times. It is, therefore, important that clinicians engage in discovering and understanding their patients' concerns and expectations in addition to making a thorough and complete diagnosis of their dental conditions. In the case presented, emphasis was placed on patient-clinician communication to correctly facilitate the desired clinical result. The final restoration consisted of a maxillary removable, implant-assisted denture and a mandibular screw-retained, fixed, implant-supported prosthesis.