Preparticipation Physical Evaluations Research Articles

Evaluating Policy Consistency in Preparticipation Physical Evaluations for High School Athletes

Sudden cardiac death in young athletes is a rare but tragic occurrence impacting families, friends, institutions, and communities. The causes of sudden cardiac death often go undetected because of the vague associated symptoms. High school athletes are required to complete a preparticipation physical examination (PPE). However, screening guidelines at the state level are flexible and can lead to an inconsistent cardiovascular assessment of student-athletes. A review of State High School Association guidelines for all 50 states and the District of Columbia evaluated consistency of current PPE policies and found variation in frequency, forms utilized, and who can complete the physical.

Coding for 2021 Preparticipation Physical Evaluations

The American Academy of Pediatrics (AAP) Coding Hotline has received numerous questions about how to bill for preparticipation physical evaluations (PPEs) or sports/camp physicals, especially evaluations that are required for return to play following COVID-19 infection.

Increasing Primary Care Follow-up after Preparticipation Physical Evaluations.

Background:Preparticipation physical evaluations (PPEs) strive to prevent injuries and sudden death in athletes. Ideally, the medical home is the best setting for completion. However, many school systems request large PPE screenings for their student-athletes. This quality-improvement project aimed to increase primary care provider (PCP) follow-up for athletes “cleared with recommendation” (CR) or “disqualified” (DQ) during our mass PPEs.Methods:Our team evaluated prior PPE data for athlete clearance and PCP follow-up for CR or DQ athletes. The prominent gaps in our PPEs were resident education, PCP or medical home identification, and communication. Our team implemented interventions during the 2018 PPEs to increase both CR and DQ athlete follow-up at the medical home.Results:Retrospective baseline data revealed that physicians categorized 11% (67/582) of athletes at our PPEs as CR or DQ. Of these athletes, the PCP and specialist follow-up rate was 13% (9/67). Our process changed to enhance athlete follow-up, but the rate only increased slightly to 15% (18/120). Medical home identification improved. Successful interventions included resident education, medical home identification, and increased communication.Conclusions:Despite our interventions, this quality-improvement initiative was unsuccessful in reaching the aim. This project found small achievements in educational opportunities, improved documentation, medial home identification for student-athletes, and lead to local changes in our standard operating procedures. Although our aim was ambitious, 100% athlete follow-up with the PCP or medical home ensures athletic safety and decreases liability for all.

Coding for Back to School and Preparticipation Physical Evaluations

As children return to school in the midst of the COVID-19 pandemic, it is expected that pediatricians will see an increased number of children who require routine preventive services or are experiencing difficulty in returning to school. This article provides codes for some of the potential reasons for visits and procedure codes for the services to address those reasons.

HPV Immunization in High School Student-Athletes Receiving Preparticipation Physical Evaluations at Mass Event Versus Other Venues.

The preparticipation physical evaluation (PPE) is a requirement for high school sport participation in most states, but its location and role in preventive health care for adolescents is often questioned. Athletes who had their PPE performed in an office setting, in particular) by their primary care physician (PCP), will have higher human papillomavirus (HPV) immunization rates than those who had their PPE done in a group setting at a mass-participation PPE. Retrospective cohort study. Level 3. The PPE forms and immunization records for athletes at a single high school were reviewed to determine the location of PPE, the signing practitioner, and HPV immunization status. A total of 488 athletes (286 males, 202 females) were included; 51% had received at least 1 dose of the HPV vaccine while 39% had completed the series. There was no significant difference in vaccination rates between examination in an office setting versus a group setting. Athletes receiving their PPE at an urgent care facility had significantly lower rates of HPV series completion than all other settings (29% vs 43%; P = 0.004). PPE completion by the athlete's PCP was associated with higher rates of vaccine series completion (46% vs 34%; P = 0.014). Athletes who completed their PPE in mass event and office-based settings had similar rates of HPV vaccine series initiation and completion. PPEs done at urgent care facilities were associated with low rates of vaccine series completion, while those done by a PCP were associated with higher rates. HPV immunization rates in athletes are low, and the PPE represents a potential opportunity to improve immunization rates.

Collegiate Athletes’ Perceptions of Osteopathic Manipulative Treatment

Many published studies have examined the effects of osteopathic manipulative treatment (OMT), but none has evaluated its role in treating collegiate athletes. The authors examined collegiate athletes' perception of OMT. A cross-sectional survey of a convenience sample of 592 collegiate athletes was conducted from two universities in the midwestern United States during August-September 2019. The athletes completed a 12-item survey during pre-participation physical evaluations at their respective institutions. Main outcome measures included pain, need for pain medication, stress and anxiety associated with injuries, and overall satisfaction with the OMT in recovery and return to sports. Fisher's exact test was used to evaluate association between the variables. The participation rate was 80.6% (477/592). Slightly fewer than 7% (31/477) of the athletes were familiar with OMT. Eighteen of the 31 athletes (58.1%) had received osteopathic manipulation as part of a treatment plan for injury. Of these athletes, 94.4% (17/18) reported a decreased need for pain medication and 83.3% (15/18) had reduced stress and anxiety related to their injury. One in three of them expressed interest in receiving osteopathic manipulation as a treatment option for an injury. The athletes reported general satisfaction with OMT in their recovery and return to sports. The findings demonstrated the interest and benefits of OMT among collegiate athletes. This evidence supported previous findings about perceived efficacy of OMT in treating patients regard-less of injury and diagnosis. Future studies need to establish causal relationship among OMT, stress and anxiety, pain, and use of pain medications.

Are You Ready for Preparticipation Physical Evaluations?

Many insurance companies do not cover preparticipation physical evaluations (PPEs). These quick tips can help you report and code them properly.

Self-Reported Physical Activity Level in Student Athletes at Preparticipation Physical Evaluations.

Quantify physical activity in healthy student athletes. Cross-sectional survey. Five Central Ohio schools during mass preparticipation physicals. Three hundred sixty-five children between the ages 10 and 18 years. Days per week of moderate to vigorous physical activity (MVPA), minutes per day of MVPA, and number of activities. Minutes per week of MVPA. One hundred eighty high school and 177 middle school subjects responded to the survey. There were 198 male and 162 female respondents. Mean age recorded 14.2 ± 1.7 years. There were no differences in activity volume based on sex. Mean minutes per week of MVPA reported 316.0 ± 231.0. High school subjects reported fewer activities than middle school cohort 2.7 ± 1.2 versus 3.2 ± 1.5 (P < 0.05). Only 7% of respondents reported exercising 60 minutes daily. Twenty-seven percent of respondents met minutes per week (420 minutes of MVPA) by training in large volumes on fewer days. Surprisingly, this physically active population did not meet the national standards of daily MVPA. In addition, middle school athletes reported more variety of activities compared with high school athletes surveyed which reached statistical significance. Screening for daily physical activity is important in the athletic population because young athletes may not meet daily MVPA recommendations.

Preparing for Preparticipation Physical Evaluations

What codes will be reported for preparticipation physical evaluations depend on the extent of service provided, the patient’s benefit plan, and your practice’s proactive handling of requests for sports physicals and other common encounters for evaluation and approval for participation.

The Preparticipation Physical Evaluation.

With rising rates of sports participation among children and adolescents, pediatricians are increasingly being called upon to perform preparticipation physical evaluations (PPEs) for young athletes. The purpose of this review article is to discuss the general structure of a comprehensive PPE and how the PPE differs from a typical health maintenance visit. The PPE focuses attention on screening for cardiac conditions that predispose athletes to sudden cardiac death with exercise. This review also addresses the debate over whether electrocardiogram screening should be a routine required part of the PPE. In addition to cardiac screening, evaluation and management of musculoskeletal injury, concussion, and the female athlete triad will be discussed in greater detail. [Pediatr Ann. 2017;46(3):e85-e92.].

High Prevalence of Obesity and High Blood Pressure in Urban Student-Athletes

To assess the prevalence of obesity and hypertension-level blood pressures in an urban, athletic adolescent population using preparticipation physical evaluation (PPE) data. The Athlete Health Organization provides free preparticipation physical evaluations to Philadelphia student-athletes via an annual mass-screening event. From 2009 to 2012, Athlete Health Organization personnel performed PPEs on more than 2700 middle school and high school athletes. The PPE included biometric information, a history, and a physical examination. Medical volunteers measured blood pressures using a manual blood pressure cuff with an aneroid manometer. The data from each PPE were collected and analyzed for prevalence of obesity, overweight, and hypertension-level blood pressure readings. A large percentage of student-athletes were found to be overweight (20%) or obese (24.0%). Many of these athletes also had stage 1 or 2 level blood pressure readings (14.8%), a finding which strongly correlated with elevated body mass index (P < .00001). The cardiovascular health of this urban adolescent athletic population is a major concern because their rates of obesity and elevated blood pressure place them at increased risk of cardiovascular complications later in life despite their participation in school athletics.

Self-Reported Physical Activity in Student Athletes at Pre-participation Physical Evaluations

Self-Reported Physical Activity in Student Athletes at Pre-participation Physical Evaluations

Mass screenings at mass participation events: MedFest at Special Olympics.

MedFest events offer preparticipation physical evaluations to Special Olympics athletes. This free service can occur as free-standing events or can take place during Special Olympics Games. The goals of MedFest are to screen for conditions that are potentially life threatening or disabling or may predispose the athlete to injury or illness. The medication, cardiac, and neurologic histories are essential components of the evaluation. The majority of athletes screened during a MedFest event will be cleared for sports participation, but many will require some type of referral for further care. It is important for the organizers of the MedFest to have prearranged protocols to ensure that the athletes efficiently receive the required evaluations.

49. Adolescent Perceptions of Pre-Participation Physical Evaluations Outside the Primary Care Office

49. Adolescent Perceptions of Pre-Participation Physical Evaluations Outside the Primary Care Office

Pre-participation physical evaluations for athletes

The pre-participation physical evaluation helps keep athletes safe. This article discusses the essential components of the PPE history and physical. Findings that should prompt further evaluation of the athlete, including those consistent with risk for sudden cardiac death, are discussed.

Evaluating Effectiveness of Pre-Participation Physical Evaluations in Screening for Sudden Cardiac Death

Sudden cardiac death occurs in competitive athletes at a rate of about 1 per 200,000 participants. Though this is a rare occurrence, procedures should be in place to help identify athletes that may be at risk. To address this concern, a panel sponsored by the American Heart Association (AHA) published recommendations in 1996, designed to screen for the most common causes of sudden cardiac death. Eighteen different recommendations were cited, all of which could easily be assessed through specific history taking and physical examination. PURPOSE: To determine how well the pre-participation evaluation (PPE) forms used by the larger high schools in the Kansas City Metropolitan area identify athletes at risk for sudden cardiac death as based on the AHA recommendations. METHODS: The Missouri and Kansas High School Athletic Associations were contacted to obtain a list of high schools in their respective states. A letter was then sent to the athletic director of the forty three 4A, 5 A and 6A schools within a 25-mile radius of Kansas City requesting a copy of the school's PPE form. Returned forms were analyzed to determine the presence or absence of the 18 different recommendations designated by the AHA for inclusion in the pre-participation screening. Percent compliance for each school was then assessed. RESULTS: Forty two of the 43 schools returned a copy of the PPE for a 98% response rate. Missouri schools used five different PPE forms; one standard form was used in Kansas. The Kansas form contained 12 of the 18 items (67%) suggested for inclusion in the pre-participation evaluation, while the five Missouri forms contained between 2 and 13 items (11–72%). CONCLUSION: This study reveals various levels of compliance in meeting AHA recommendations to screen for sudden cardiac death and suggests athletes at risk for sudden cardiac death may not be identified prior to participating in athletics.

Preparticipation Physical Evaluations for High School Athletes:Time for a New Game Plan

For several decades, physicians have conducted preparticipation physical evaluations (PPEs) hoping to reduce the morbidity and mortality associated with high school sports. We argue in this Brief Commentary that the PPE as currently practiced is ineffective and illogical. We propose a research agenda that would provide data to more effectively promote adolescent health both on and off the playing field.

Preparticipation screening of children for sports. Current recommendations.

Every year physicians all over the world are asked to perform preparticipation physical evaluations (PPE) for children involved in sports. The PPE should be brief yet comprehensive enough to determine which athletes are at risk. In addition, the examination may help determine the athlete's general health and maturity level, uncover any disqualifying conditions and may also help establish a doctor-patient relationship. PPEs should be performed 4 to 6 weeks prior to initiation of the sport and be repeated every 1 to 3 years. A station-based exam may help evaluate large numbers of athletes within a limited time period. The history is the most important aspect of the PPE and should focus on prior cardiovascular complications, a family history of cardiovascular death before 50 years of age and any other limiting medical problems. A general physical examination should be performed to focus on areas involved in sports participation. Laboratory tests are not usually necessary. Disqualifying conditions may be determined based on the physical abnormality present and the amount of contact or energy involved in the sport to be played. Throughout the world, sports participation is growing rapidly. Although these guidelines have been drafted by a consortium of sports-related and general practice groups in the US, they can easily be applied worldwide. Unfortunately the health of young adults in developing countries may not be as good as that of those residing in more industrialised countries, therefore each athlete must be considered individually. With this type of individualised approach the examining physician can make informed and intelligent decisions concerning the athlete's participation.