title: State-specific differences in school sports preparticipation physical evaluation policies.
abstract: OBJECTIVE
  This study evaluated the current preparticipation physical evaluation (PPE) administrative policies and cardiovascular screening content of all 50 states and Washington, DC.
  
  
  METHODS
  PPE policies, documents, and forms from all 50 states and Washington, DC, were compared with the preparticipation physical evaluation-fourth edition (PPE-4) consensus recommendations. All electronic documents were publicly available and obtained from state interscholastic athletic associations.
  
  
  RESULTS
  Fifty (98%) states required a PPE before participation. Most states (53%, n = 27) required a specific PPE form, whereas 24% (n = 12) of states recommended a specific form. Twenty-three states (45%) required or recommended use of the PPE-4 form or a modified version of it, and 27 states (53%) required or recommended use of outdated or unidentifiable forms. Ten states (20%) had not revised their PPE forms in >5 years. States permitted 9 different health care providers to administer PPEs. Only 22 states (43%) addressed all 12 of the PPE-4 personal and family history cardiovascular screening items, and 2 states (4%) addressed between 8 and 11 items. For the remaining 26 states, most (29%) addressed ≤3 screening items.
  
  
  CONCLUSIONS
  Our results show that inconsistencies in PPE policies exist nationwide. Most states have been slow to adopt PPE-4 recommendations and do not adequately address the personal and family cardiovascular history questions. Findings suggest a need for PPE standardization nationwide and adoption of an electronic PPE process. This approach would enable creation of a national database and benefit the public by facilitating a more evidenced PPE.
authors.affiliation: George Mason University, Sports Medicine Assessment, Research & Testing (SMART) Laboratory, Manassas, Virginia; and scaswell@gmu.edu.
authors.forename: Shane V
authors.initials: SV
authors.lastname: Caswell
authors.affiliation: George Mason University, Sports Medicine Assessment, Research & Testing (SMART) Laboratory, Manassas, Virginia; and.
authors.forename: Nelson
authors.initials: N
authors.lastname: Cortes
authors.affiliation: George Mason University, Sports Medicine Assessment, Research & Testing (SMART) Laboratory, Manassas, Virginia; and.
authors.forename: Mary
authors.initials: M
authors.lastname: Chabolla
authors.affiliation: George Mason University, Sports Medicine Assessment, Research & Testing (SMART) Laboratory, Manassas, Virginia; and.
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Ambegaonkar
authors.affiliation: George Mason University, Sports Medicine Assessment, Research & Testing (SMART) Laboratory, Manassas, Virginia; and.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Caswell
authors.affiliation: Children's Hospital of The King's Daughters and Eastern Virginia Medical School, Norfolk, Virginia.
authors.forename: Joel S
authors.initials: JS
authors.lastname: Brenner
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis; D002648:Child; D006801:Humans; D010808:Physical Examination; D012572:School Health Services; D013177:Sports; D014481:United States
keywords: PPE; athletes; cardiovascular screening; health; high school sports; physical; screening