NATA Position Statement-PPE - Institute for Collegiate ... · NATA Position Statement ... SCD occurs in about 0.5 per 100,000 high school ... NATA Position Statement-PPE [Compatibility

NATA Position Statement

Preparticipation Physical Examination

and Disqualifying Conditions

2014

Warm up Questions

� Do you require PPE’s or “perform the PPE”?

� Who is the Medical Professional signature?

� General Practice Physician (DO or MD)

� Orthopedic Surgeon

� PA, Nurse, Chiropractor

� What is the purpose of the PPE?

Objective of the Position Statement

� To present athletic trainers with

recommendations for the content and

administration of the Preparticipation Physical

Examination (PPE) as well as considerations

for determine safe participation in sports and

identifying disqualifying conditions.

Interesting Facts

� 2010-2011 = 7.6 million High School Students

used a standardized PPE, p102

� A complete Medical History identifies

approximately 75% of problems that affect initial

athletic participation. p106

� SCD occurs in about 0.5 per 100,000 high school

athletes per academic year. p107

� EIB in elite athletes, 6-21%, so screen. p113

� 30% of young adults (18-25) had the highest level

of Mental Health Illness, p115

Background

� How long have we been doing PPEs? � 40 years according to the NATA.

� Are they standardized?� Example: High School State Association

� Why do PPE’s? � NCAA did not mandate PPE’s for all athletes until

recently.

� Recommendations – 29 specific statements� Each “graded”, SORT – Strength of

Recommendation Taxonomy. A, B, C

SORT

� “A” – Recommendation based on consistent and good quality experimental evidence (morbidity, mortality, exercise and cognitive performance, physiologic responses)

� “B” – Recommendation based on inconsistent or limited quality Experimental Evidence.

� “C” – Recommendation based on consensus; usual practice, opinion, disease-oriented evidence, case studies of dx, tx, prevention , or screening.

American Medical Association Group on

Science and Technology

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.

2. Do not disqualify athletes unless there is a

compelling medical reason.

Only “A” Recommendation

� Orthopedic Screening

9. The musculoskeletal hx screening and

examination can be combined for

asymptomatic Athletes with no previous

injuries. If player has either a previous injury

or signs . . The relevant elements of a site

specific examination should be performed.

Sections of Recommendations

� Medical and Family History

� Physical Examination

� General Health Screening

� Cardiovascular Screening

� Neurologic Screening

� Orthopaedic Screening

� General Medical Screening

� Medical Use

� Nutritional Assessment

� Heat and Hydration Related Illness Risk Factors

� Mental Health Considerations

Table 2 –The 12-Element American Heart

Association Recommendations for PPE

Heart� Medical Hx

� PersonalX

1. Exertional chest pain/discomfort

2. Unexplained syncope/near syncope

3. Excessive exertional and unexplained dyspnea/fatigue, associated with exercise

4. Prior recognition of a heart murmur

5. Elevated system Blood Pressure

Table 2 Cont.

� Family Hx

6. Premature death before 50 y due to heart disease in >1

7. Disability from heart disease in a close relative age < 50y

8. Specific knowledge of certain cardiac conditions in family members, examples listed page 104

Table 2 Cont.

� Physician Examination

9. Heart Murmur

10. Femoral pulses to exclude aortic coarctation

11. Physical stigmata of Marfan Syndrome

12. Brachial Artery Blood pressure (sitting position) taken in both arms.

Other Tables of Note

� Table 3 - Questions Regarding Presence of Cardiovascular Risk Factors

� Table 4 - The 90-Second Musculoskeletal Screening Examination

� Table 5 – Conditions Associated with Abnormal Arterial Pulse Waves

� Table 6 – Classification of Sports According to Cardiovascular Demands

� Table 7 – Spine Condition Participation Recommendations

� Table 8 – Classification of Sports by Contact

� Table 9 – Mental Health-Related Survey

Table 9 Mental Health Survey (Yes or No)

� I often have trouble sleeping.

� I wish I had more energy most days of the week.

� I think about things over and over.

� I feel anxious and nervous much of time.

� I often fell sad or depressed.

� I struggle with being confident.

� I don’t feel hopeful about the future.

� I have a hard time managing my emotions. (Frustration, anger, impatience)

� I have feelings of hurting myself or others.

Recommendations continued

� Administration of PPE #22 - 27

� Determining Clearance # 28-29

29. Team Physicians and Institutions have the

legal right to restrict an individual from

participating in athletics, provided the

decision is individualized, reasonably make,

and based on competent medical evidence.

Let’s Stop and Discuss

� How to you do it?� Stations vs Individuals?

� In house vs Community Medical Professionals?

� What do you do that is GREAT?

� Anything you want to improve?

� Red Flags< how does your referral process work?

� Do you address all “areas” including mental health?

The Evidence: Background and Literature

Review

� “Evidence to support the above-referenced

recommendations and the best practices in

developing and delivering a comprehensive

PPE follows.

� Good read! Pages 106 – 115.

Laboratory and Diagnostic Screening

� Anemia

� Sickle Cell Trait

� Diabetes Mellitus

� Lipid Disorders

� Exercised-Induced Bronchospasm (EIB)

� Medication use

� Nutritional Assessment

� Heat-Related Illness and Hydration Risk Factors

� Mental Health Consideration

� Medication use� Document everything (supplements/medications)

and justify including energy drinks.

� Nutritional Assessment� See previous NATA Position Statement for

screening.

� Heat-Related Illness and Hydration Risk Factors� See precious NATA Position Statement

� Mental Health Consideration � 1 in 5 teens in the US suffer from a mental

disorder sever enough to affect daily life. (2010)

� REFER to a Psychologist!

PPE Administration

� FERPA and HIPPA

� Timing

� 4-6 weeks prior to pre-season practice

� Instrument

� The American Academy of Pediatrics template

� Method

� Athlete’s Personnel Physician or Larger Scale Screening

� Personnel

� Physician (Doctor of Medicine or Osteopathy) with clinical training.

� Determination of Clearance

� Occasionally, an abnormality or condition is found that may limit an athlete’s participation or predispose them to further injury.

� A specific risk analysis to provide guidance has not been developed.

Determination of Clearance

1. Does the condition pose an unacceptable

risk or place the athlete at increased risk?

2. Does the condition place other participants

at risk for injury?

3. Can the athlete safely participate with

treatment (eg, medication, bracing)?

Determination of Clearance cont.

4. Can limited participation be allowed while

Tx is being completed?

5. If clearance is denied for certain sports

categories, which activities can the athlete

safely participate?

Discussion and Questions

Take Away Points