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To the Editor: The study by Dr Pfister and colleagues1 raises questions about the utility of the preparticipation physical examination (PPE) for collegiate athletes. The authors found that many PPEs do not include the 12 American Heart Association (AHA) 1996 Consensus Panel recommendations for preparticipation cardiovascular screening of athletes and conclude that the current system may expose athletes to a "flawed preparticipation cardiovascular screening process that reduces the reasonable expectation of detecting pertinent cardiovascular abnormalities in some athletes."
Alternatively, one could reach different conclusions: (1) the PPE process is flawed because the current format does not incorporate many of the recommendations presented by the United States Preventive Services Task Force (USPSTF),2 and (2) no studies have demonstrated a difference in morbidity or mortality rates resulting from different PPE formats.
The current recommended format incorporates the recommendations of the AHA and a statement by their consensus panel.3 The USPSTF also provides recommended screening protocols for individuals in this age group. As screening for risk factors is important for every child and young adult, any recommendation for screening should be applicable to the entire population. This screening is important whether or not the individual participates in organized athletics because physical activity is beneficial at any age. Therefore, the recommendations of the USPSTF would also serve as a "gold standard" in the medical screening of athletes.
The PPE in its current form has no effect on the morbidity and mortality rates in athletes. There is a need for instruments that better prevent injuries and deaths associated with athletic participation and physical activity, irrespective of participation in organized athletics. Perhaps the recommendations of the USPSTF should be adopted and efforts should be focused on the more common health-related issues found in young athletes and nonathletes alike (eg, substance abuse, sexually transmitted diseases, trauma, homicide, and suicide). The only currently recommended screening tests for the general population aged 11 to 24 years are height and weight, blood pressure, Papanicolaou smear, chlamydia screen, rubella serology or vaccination, and assessment of problem drinking.2
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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