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    June 2013

    Preparticipation Exams for High School Athletes

    Preparticipation exams (PPE) are an effective means of establishing a basic standard of health for interscholastic athletes. State athletic associations mandate the PPE's content and frequency and who can administer it; some require a standardized form. Several medical associations collaborated to develop a Preparticipation Physical Evaluation Guide, establishing good practices for identifying athletes who may be at increased risk of harm.

    Educational institutions should review their PPE practices with legal counsel to ensure compliance with state regulations. At a minimum, PPEs should include a:

    • Family medical history to screen for undetected genetic concerns, such as cardiovascular abnormalities or blood disorders
    • Personal medical history
    • Physical exam
    • Series of interview questions used to identify abnormal conditions that limit participation

    PPEs typically do not include sophisticated tests. Rather, they establish a baseline for play and do not guarantee an athlete's fitness. Schools may conduct separate neurocognitive baseline testing for sports in which concussions are a risk.

    Only accept exams documented on your school form, and recommend that athletes and their parents or guardians provide the correct form to their physician. The American Academy of Pediatrics offers sample documentation, including health history, physical examination, and clearance forms, and a supplemental history for athletes with special needs.

    Which Teams Should Require a PPE?

    The exam is recommended for all school-sponsored athletics. Completed forms must be turned in before tryouts without exception. Some institutions distribute forms in the spring for the coming year and remind students again before tryouts.

    Who Should Administer the PPE?

    Consult your state athletic association's rules. State-licensed health care providers usually conduct PPEs. The youth athletic safety information site describes models for PPE administration using a primary care physician, team physician, or contracted health care providers. The athlete's primary physician offers the advantage of patient familiarity. Encourage parents to confirm that their primary physician has exam administration experience.

    What Do the Results Mean?

    If the health care provider does not grant unqualified clearance, additional steps may be necessary before the student can participate, including:

    • Testing by a specialist
    • Requiring the student to participate in a less risky sport
    • Modifying the activity
    • Discussing the decision to play with the student and parents
    • Requiring a signed assumption of risk form

    The PPE Is Not Intended to Exclude Students From Athletics

    Failure to offer accommodations may be viewed as discrimination under federal and state disability laws.

    How Long Is the PPE Valid?

    Follow state requirements and consult with a medical professional about annual screening for returning athletes, which can range from a complete PPE to reviewing personal and family history to a blood pressure check. An up-to-date form must be on file for participation. Records should be retained, in most cases, for four to five years after the student graduates.


    American Academy of Pediatrics: Medical Conditions Affecting Sports Participation

    National Athletic Trainers' Association: Appropriate Medical Care for the Secondary School-Age Athlete

    American Family Physician: Cardiovascular Screening of Student Athletes

    Academy of the Holy Cross: Athletic Program Health Form 


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