O3296: Evaluating the Adoption of the Preparticipation Physical Evaluation—5th Edition History Form across the United States

Background: Preparticipation physical evaluations enable clinicians to screen for and/or identify potential health risks that could predispose young athletes to illness, injury, or even death. In 2019, the American Academy of Pediatrics (AAP) published the Preparticipation Physical Evaluation—5th Edition (PPE-5). The PPE-5 contains the most recent consensus guidance from the AAP and other key professional organizations on preparticipation physical evaluation health information in need of collection. The PPE-5 history form includes 7 sections with 42 items addressing: general health history, anxiety and depression, general health concerns, heart health, bone and joint, medical history, menstrual history, and COVID-19. The PPE-5 history form differs significantly from its predecessor (PPE-4) through inclusion of a mental health screening section and refinement of items pertaining to cardiac health and concussion history. Past studies evaluating widespread use of previous PPE editions revealed significant nationwide variations; however, to our knowledge, adoption of the complete PPE-5 history form across the United States has yet to be explored.
Therefore, the objective of this study was to evaluate adoption of the PPE-5 history form in all 50 states and Washington DC.

Methods: In February 2025, individual National Federation of State High School Associations (NFHA) member organization websites (n=51) were queried to obtain downloadable preparticipation history forms in English. All available preparticipation history forms were comprehensively evaluated to assess whether each item contained within the PPE-5 was completely addressed, partially addressed, or absent.

Results: A downloadable preparticipation history form was available on individual high school athletic association websites in 47 states and Washington, DC. Of these, 31 states (65%) recommended use of the PPE-5 history form or a slightly modified version. PPE-5 adoption varied by state and health section. State adoption of complete PPE-5 sections was as follows: general health history (67%), anxiety and depression screening (63%), general health concerns (75%), heart health (69%), bone and joint (73%), medical history (65%), menstrual history (63%), and COVID-19 (21%). It was not uncommon for history forms to include additional non-PPE-5 items (e.g., recent viral infection history, protective eyewear use).

Conclusion: State adoption of preparticipation evaluation history forms demonstrated inconsistencies nationwide. While most states generally adhere to PPE-5 recommendations, critical items —such as sickle cell disease history, cardiac health screening questions, or mental health screening—are frequently omitted, potentially putting athletes at risk of serious health consequences. These findings highlight the need for greater nationwide standardization of preparticipation physical evaluations and further adoption of PPE-5 recommendations. It is imperative for pediatricians to be aware of PPE-5 adoption their state and supplement their preparticipation physical evaluations with additional discussion.