Presentation on theme: "NATA Position Statement"— Presentation transcript:
1 NATA Position Statement Preparticipation Physical Examination and Disqualifying Conditions2014
2 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 SurgeonPA, Nurse, ChiropractorWhat is the purpose of the PPE?
3 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.
4 Interesting Facts= 7.6 million High School Students used a standardized PPE, p102A complete Medical History identifies approximately 75% of problems that affect initial athletic participation. p106SCD occurs in about 0.5 per 100,000 high school athletes per academic year. p107EIB in elite athletes, 6-21%, so screen. p11330% of young adults (18-25) had the highest level of Mental Health Illness, p115
5 Background How long have we been doing PPEs? Are they standardized? 40 years according to the NATA.Are they standardized?Example: High School State AssociationWhy do PPE’s?NCAA did not mandate PPE’s for all athletes until recently.Recommendations – 29 specific statementsEach “graded”, SORT – Strength of Recommendation Taxonomy. A, B, C
6 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.
7 American Medical Association Group on Science and Technology 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.Do not disqualify athletes unless there is a compelling medical reason.
8 Only “A” Recommendation Orthopedic Screening9. 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.
9 Sections of Recommendations Medical and Family HistoryPhysical ExaminationGeneral Health ScreeningCardiovascular ScreeningNeurologic ScreeningOrthopaedic ScreeningGeneral Medical ScreeningMedical UseNutritional AssessmentHeat and Hydration Related Illness Risk FactorsMental Health Considerations
10 Table 2 –The 12-Element American Heart Association Recommendations for PPE Heart Medical HxPersonalX1. Exertional chest pain/discomfort2. Unexplained syncope/near syncope3. Excessive exertional and unexplained dyspnea/fatigue, associated with exercise4. Prior recognition of a heart murmur5. Elevated system Blood Pressure
11 Table 2 Cont.Family Hx6. Premature death before 50 y due to heart disease in >17. Disability from heart disease in a close relative age < 50y8. Specific knowledge of certain cardiac conditions in family members, examples listed page 104
12 Table 2 Cont. Physician Examination 9. Heart Murmur 10. Femoral pulses to exclude aortic coarctation11. Physical stigmata of Marfan Syndrome12. Brachial Artery Blood pressure (sitting position) taken in both arms.
13 Other Tables of NoteTable 3 - Questions Regarding Presence of Cardiovascular Risk FactorsTable 4 - The 90-Second Musculoskeletal Screening ExaminationTable 5 – Conditions Associated with Abnormal Arterial Pulse WavesTable 6 – Classification of Sports According to Cardiovascular DemandsTable 7 – Spine Condition Participation RecommendationsTable 8 – Classification of Sports by ContactTable 9 – Mental Health-Related Survey
14 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.
15 Recommendations continued Administration of PPE #Determining Clearance # 28-2929. 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.
16 Let’s Stop and Discuss How to you do it? What do you do that is GREAT? 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?
17 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.
18 Laboratory and Diagnostic Screening AnemiaSickle Cell TraitDiabetes MellitusLipid DisordersExercised-Induced Bronchospasm (EIB)Medication useNutritional AssessmentHeat-Related Illness and Hydration Risk FactorsMental Health Consideration
19 Nutritional Assessment Medication useDocument everything (supplements/medications) and justify including energy drinks.Nutritional AssessmentSee previous NATA Position Statement for screening.Heat-Related Illness and Hydration Risk FactorsSee precious NATA Position StatementMental Health Consideration1 in 5 teens in the US suffer from a mental disorder sever enough to affect daily life. (2010)REFER to a Psychologist!
20 PPE Administration FERPA and HIPPA Timing Instrument Method 4-6 weeks prior to pre-season practiceInstrumentThe American Academy of Pediatrics templateMethodAthlete’s Personnel Physician or Larger Scale Screening
21 Determination of Clearance PersonnelPhysician (Doctor of Medicine or Osteopathy) with clinical training.Determination of ClearanceOccasionally, 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.
22 Determination of Clearance Does the condition pose an unacceptable risk or place the athlete at increased risk?Does the condition place other participants at risk for injury?Can the athlete safely participate with treatment (eg, medication, bracing)?
23 Determination of Clearance cont. Can limited participation be allowed while Tx is being completed?If clearance is denied for certain sports categories, which activities can the athlete safely participate?