Pre-participation Screening: Difference between revisions
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== Cardiac Screening == | == Cardiac Screening == | ||
A cardiac screen is a very important aspect of pre-participation screening. This will typically occur during the medical portion of the PPE <ref name="Sanders" />. Some items that should be included are blood pressure, pulse, respiration, auscultation for heart murmurs, palpation of femoral pulses, examination for the physical stigmata of Marfan Syndrome, and a brachial artery blood pressure take from the sitting position <ref name="Maron">Maron, B., Thompson, P., Puffer, J., et al.(1996) Cardiovascular pre-participation screening of competative athletes. A statement for the health professionals from the Sudden Death Committee and Congenital Cardiac Defects Committee. American Heart Association.</ref> . Sudden Cardiac Death or SCD is a rare but potential hazard that can occur with sports participation. It can often be the first and definitive manifestation of an underlying cardiac pathology<ref name="Corrado">Corrado, D., Basso, C., Schiavon, M., Pelliccia, A., Thiene, G., (2008) Pre-participaiton screening of young competative athleltes for prevention of sudden cardiac death. Journal of American College of Cardiology. 52(5) 1981-1989</ref>. A figure in the referenced article below shows a clinical decision tree for cardiovascular pre-participation screening <ref name="Corrado" />. It is evident that an ECG is vital to determine the risk according to this study and a few others. This ECG screening allows for the identification of still asymptomatic athletes with at risk cardiovascular diseases <ref name="Corrado" />. The American College of Sports Medicine or ACSM also has a risk classification that is well researched and useful for the cardiac component of a pre-participation. It uses risk factors to classify individuals into risk groups and advises whether or not there should be a medical test or exercise test recommended before participation in exercise or activity. A link to this article and its risk classification schema can be found below<ref>Thompson, P., Arena, R., Riebe, D., Pescatello, L. (2013) ACSM's new preparticipation health screening recommendations from ACSM's guidlines for exercise testing and prescription, ninth edition. American College of Sports Medicine Current Sports Medicine Reports. 215-217.</ref> . As with the physical examination portion of the PPE there are no concrete guidelines to the cardiac screening but there are recommendations that can trusted and relied upon for screening purposes. If any irregularities are found or observed the patient should be referred on the the appropriote individual. | |||
== Economic Considerations == | == Economic Considerations == | ||
Revision as of 01:55, 18 November 2015
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Purpose[edit | edit source]
Approximately 46.5 million children and 7.7 million high-school students in the United States participate in organized sports each year [1]. As the number of individuals participating in sports continues to increase, so does the number of sport-related injuries. In 2012, over 1.35 million children received emergency care for sports-related injuries [2], and 39 young athletes suffered from sports-related death [1]. The purpose of pre-participation screening in sports is to decrease the number of sport-related injuries and death by identifying individual abnormalities that may predispose an athlete to injury [3].
Traditionally, pre-participation screenings consisted of a medical examination and a subjective history to identify potential risk factors for further injury such as cardiovascular conditions, asthma, diabetes, etc. [4]. The American Heart Association (AHA) provides an outline of appropriate examination components and subjective history questions. Protocols such as the one provided by the AHA ensure consistent and uniform assessments [5]; however, many professionals argue these protocols are not individualized enough to thoroughly analyze injury risk [4] [3]. In more recent years, professions suggest functional movement assessments be incorporated into pre-participation screens to identify any abnormalities in movement patterns that may predispose to musculoskeletal injuries [3]. In addition, incorporation of neurocognitive and balance assessments, such as the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) and Balance Error Scoring System (BESS), into the pre-participation screening protocol provide a baseline measurement that can be compared to post-injury scores to identify the severity of an injury [6].
Timing, Setting, and the Medical Team[edit | edit source]
Subjective History[edit | edit source]
Physical Examination[edit | edit source]
It is important to screen athletes before they participate in sports in order to establish a baseline of ability, evaluate the athlete's risk for injury, and direct the interventions that might be required. There is not a great deal of research that backs specific processes and components but some professional organizations have some general recommendations [7]. There are many possible elements to a PPE which can include, a medical history, medical examination, musculoskeletal examination, performance testing, and laboratory studies[7]. The sports physical therapists can conduct musculoskeletal physical examinations as a part of the PPE. There are many ways that a musculoskeletal examination can be carried out. Traditionally we have seen impairment based PE's administered that look at strength, range of motion, endurance, and so on [3]. Recently a growing trend has involved looking at functional movements to assess an athletes risk for participating in sports. The functional movement system was developed as a systematic way to examine movement and classify injury risk[3]. The FMS has 7 fundamental movement patterns that challenge mobility and stability of an individual[3]. A score is calculated from these 7 fundamental movement patterns that can determine whether someone is at risk for injury or not[3] The FMS can also be used with Y balance test scores, and demographic risk factors to calculate an injury risk with an algorithm. This algorithm can categorize athletes at risk before participation and can be used for return to sport decisions as well [8]. This article is referenced below and the website to use the algorithm is move2perform.com. In summary there are endless combinations of items that can make up a physical examination for a PPE, the growing trend is to move away from an impairment-based examination into a functional standardized assessments that determines a quantifiable risk number.
Cardiac Screening[edit | edit source]
A cardiac screen is a very important aspect of pre-participation screening. This will typically occur during the medical portion of the PPE [7]. Some items that should be included are blood pressure, pulse, respiration, auscultation for heart murmurs, palpation of femoral pulses, examination for the physical stigmata of Marfan Syndrome, and a brachial artery blood pressure take from the sitting position [9] . Sudden Cardiac Death or SCD is a rare but potential hazard that can occur with sports participation. It can often be the first and definitive manifestation of an underlying cardiac pathology[10]. A figure in the referenced article below shows a clinical decision tree for cardiovascular pre-participation screening [10]. It is evident that an ECG is vital to determine the risk according to this study and a few others. This ECG screening allows for the identification of still asymptomatic athletes with at risk cardiovascular diseases [10]. The American College of Sports Medicine or ACSM also has a risk classification that is well researched and useful for the cardiac component of a pre-participation. It uses risk factors to classify individuals into risk groups and advises whether or not there should be a medical test or exercise test recommended before participation in exercise or activity. A link to this article and its risk classification schema can be found below[11] . As with the physical examination portion of the PPE there are no concrete guidelines to the cardiac screening but there are recommendations that can trusted and relied upon for screening purposes. If any irregularities are found or observed the patient should be referred on the the appropriote individual.
Economic Considerations[edit | edit source]
Clearance for Sports[edit | edit source]
Medicolegal Considerations[edit | edit source]
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ 1.0 1.1 National Athletics Trainers Association. Youth Sport Safety Summit, 2014. http://www.youthsportssafetyalliance.org/sites/default/files/Statistics.pdf.
- ↑ Ferguson RW. Safe Kids Worldwide Analysis of Consumer Product Safety Commsiion (CPSC) National Electronic Injury Surveillance System (NEISS) data, 2013.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Cook G, Burton L, Hoogenboom B. Pre-participation screening: the use of fundamental movement as an assessment of function – part 1. N Am J Sport Phys Ther 2006;1(2):62-72. Cite error: Invalid
<ref>tag; name "Cook" defined multiple times with different content Cite error: Invalid<ref>tag; name "Cook" defined multiple times with different content Cite error: Invalid<ref>tag; name "Cook" defined multiple times with different content Cite error: Invalid<ref>tag; name "Cook" defined multiple times with different content - ↑ 4.0 4.1 Casa DJ, Guskiewicz K M, Anderson SA, Courson RW, Heck JF, Jimenez CC, McDermott BP, Miller MG, Stearns RL, Swartz EE, Walsh KM. National Athletic Trainers’ Association position statement: preventing sudden death in sports. J Athl Train 2012;41(1):96-118.
- ↑ Mahmood S, Lim L, Akram Y, Alford-Morales S, Sherin K, Prevention Practice Committee. Screening for sudden cardiac death before participation in high school and collegiate sports: American College of Preventative Medicine position statement on preventative practice. Am J Prev Med 2013;45(1):130-133.
- ↑ Kerr ZY, Snook EM, Lynall R, Dompier TP, Sales L, Parsons JT, Hainline B. (2015). Concussion-related protocols and preparticipation assessments used for incoming student-athletes in National Collegiate Athletic Association member institutions. J Athl Train 2015;50(11):000-000.
- ↑ 7.0 7.1 7.2 Sanders, B., Blackburn, T., Boucher, B., (2013). Preparticipation screening the sports physcial therapy perspective. The international journal of sports physical therapy. 8(2)180-193
- ↑ Plinky, P., Butler, R., Kiesel, K., Underwood, F. (2013) Field-expedient screening and injury risk algorithm categories as predictors of noncontact lower extremity injuries. Scandinavian Journal of Medicine and Science in Sports. 1-8
- ↑ Maron, B., Thompson, P., Puffer, J., et al.(1996) Cardiovascular pre-participation screening of competative athletes. A statement for the health professionals from the Sudden Death Committee and Congenital Cardiac Defects Committee. American Heart Association.
- ↑ 10.0 10.1 10.2 Corrado, D., Basso, C., Schiavon, M., Pelliccia, A., Thiene, G., (2008) Pre-participaiton screening of young competative athleltes for prevention of sudden cardiac death. Journal of American College of Cardiology. 52(5) 1981-1989
- ↑ Thompson, P., Arena, R., Riebe, D., Pescatello, L. (2013) ACSM's new preparticipation health screening recommendations from ACSM's guidlines for exercise testing and prescription, ninth edition. American College of Sports Medicine Current Sports Medicine Reports. 215-217.
