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.

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

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.

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.

History of Medical Conditions

The medical history should identify any known medical conditions (i.e., asthma, epilepsy, diabetes mellitus, hepatitis, high blood pressure, coagulation disorders, one functional kidney, one functional or anatomical eye, juvenile rheumatoid arthritis, spondylolysis, anorexia nervosa, pregnancy, depression, attention-deficit/hyperactivity disorder, and others).2–4,7 Such knowledge will allow for proper management of these conditions in the athlete to ensure safe and continued sport participation.

History of Heat Disorders

A past history of heat-related illness is a risk factor for recurrent heat-related illness and this will allow for appropriate preventive measures to be implemented for the athlete.

History of Musculoskeletal Conditions

Ask about previous or current musculoskeletal problems so that they can be clearly identified and treated, resulting in minimal interference with the athlete’s sports performance.5,11 If there is a positive history for previous musculoskeletal injury, further inquiry is important regarding the nature of this injury, what treatment occurred, if there was full recovery from the injury or injuries, and if the athlete is engaged in overtraining.12,13 If the athlete is allowed to return to sports without full rehabilitation, risks for additional injury are increased. It is important to rule out other causes of musculoskeletal pain or injury, such as neoplasm or infection.

History of Head and Neck Injuries

Minor head trauma is not uncommon in youth sports; it is important to evaluate for this possibility.14 Thus a detailed history is taken regarding head and neck injury, as outlined in Table 8-2. Sport-related concussion may result in acute and chronic sequelae (see Chapter 11).15–17

History of Breathing Problems

Asthma is the most common chronic disease of children and adolescents and is diagnosed in approximately five million individuals younger than 18 years in the United States.18–21 Asthma can have direct effects on the quality of life and if not adequately treated can adversely impact the athlete’s sports performance. Pulmonary problems in athletes are discussed in Chapter 12.

History of Cardiovascular Disorders

A careful cardiovascular disorders assessment is critical to look for previously not recognized conditions while allowing an athlete to participate in sports at varying levels.22–27 Cardiovascular screening (see Chapter 14 for detailed discussion) seeks to find those at increased risk for exercise-induced sudden cardiac death. A cardiac cause represents 95% of sudden death in adolescent and young adult athletes, while sudden cardiac death occurs in one to two per 200,000 athletes per year in the United States.21,27

Menstrual and Gynecologic History

The gynecologic history should seek information about menarche (age of menses onset), date of the last menstrual period, and the presence of menstrual problems such as amenorrhea (primary or secondary), dysfunctional uterine bleeding, or dysmenorrhea.28,29 Female athletes involved in highly competitive sports may be at risk for the female athlete triad characterized by menstrual abnormality (such as amenorrhea), disordered eating behaviors, and osteopenia.28–31

The athlete should be screened for the possibility of sexual abuse and harassment.32,33 Sexual harassment of female athletes can occur in a variety of ways, including salacious comments or suggestions, ridiculing of ability, sex-based comments, written threats with or without lewd jokes, unsolicited attention, sexual bullying, and others.32,33 Specific issues of female athletes are further explored in Chapter 9.

Medication History

The SPPE should ask about what medication(s) the athlete is taking, and the athlete as well as the parents should understand potential adverse effects of these drugs.3,4 Sometimes, sports officials should know about these medications as determined by the physician and the family (athlete as well as the parents or guardians). For example, the athlete should understand if the drug has a negative effect on sports performance, for example, beta blockers prevent optimal heart rate increase in response to physical activity. If the athlete is not in compliance with recommended medication, sports performance may be reduced, such as in the individual with poorly controlled diabetes mellitus who experiences diabetic reactions.3,4,34

Nonprescription drugs can lead to problems, as noted in the increased risks for heat illness if taking antihistamine medication, increased risk for trauma-induced bleeding in the athlete taking aspirin (acetyl salicylic acid) or increased risk for abdominal pain and bleeding from nonsteroidal anti-inflammatory drugs (NSAIDs). Performance-enhancing drugs and supplements are reviewed in Chapter 7.35–37

Presence of Allergies

Ask about allergies including both environmental and drug allergies that may interfere with sports performance. The athlete should have appropriate medication for treating acute allergic reactions. An epinephrine injection kit should always be available for emergency treatment of anaphylactic reactions.

History of a Recent Febrile Illness

The athlete may be concerned about an upper respiratory tract infection or febrile illness that may interfere with optimal performance. However, a more serious threat is the uncommon development of myocarditis that may be the result of a viral illness leading to potentially lethal cardiac arrhythmias and sudden death (see Chapter 18).

History of Ophthalmologic Conditions