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A careful medical history and physical examination are the cornerstones of effective clinical practice when caring for children and adolescents.1 The frequency, format, contents, and usefulness of a sports preparticipation evaluation (SPPE) in predicting and preventing morbidity and mortality related to sport participation have not been validated by any long-term systematic research. Studies suggest that between 0.3% and 1.3% of the athletes are disqualified from participation based on SPPE findings and between 3.2% and 13.9% of the athletes require further evaluation.2 In the United States all high school athletes are required to have an annual SPPE.
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The athlete should receive an SPPE at least annually, preferably 6 to 8 weeks before the season or event to allow for adequate rehabilitation of most injuries that may be found and to allow for further medical evaluation of any other health problems identified.2–6 SPPE is not meant to replace an annual comprehensive evaluation by the athlete's primary care pediatrician.7 The main goals of the SPPE are to assess the general health of the athlete, to identify any health condition that may predispose the athlete to increased risk for injury or illness, and to match the athlete with the sport best suited for him or her depending on physical health, cognitive abilities, and athletic abilities.8–10
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SPPE is best done in an office setting by the athlete's primary care physician. This will allow for continuity of care and exploration of a wider range of health-related issues in a confidential manner. SPPE is not a substitute for recommended health maintenance or preventive health visits. However, for some athletes SPPE may be the only health care visit. These athletes must be strongly recommended to establish care with a primary care physician. It is also suggested that SPPE should be integrated into the regular well child or preventive health care visits after 6 years of age thus avoiding the need for a separate visit for SPPE.
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A comprehensive SPPE medical history as obtained from the athlete and parents is the most important aspect of the SPPE and can identify about three-quarters of important issues associated with sports participation. Youth are more comfortable fully clothed while the medical history is obtained. Data can be obtained from various sources, including the athlete, parents or guardians, previous medical records, and even school records. Standard questionnaires may be used for initial screening. Key elements to be explored in the history are summarized in Table 8-1.
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