Female Athlete Triad Screening in National Collegiate Athletic Association Division I Athletes: Is the Preparticipation Evaluation Form Effective?

Mencias T., Noon M., Hoch AZ. Clincial Journal of Sports Medicine. 2012: ahead of publisher

The number of female athletes continues to increase in collegiate athletics; however, there are medical issues specific to females (e.g., female athlete triad [triad]) that may not be getting enough attention in the preparticipation evaluation (PPE). The purpose of this study was to assess the screening practices and PPE forms used to identify college athletes at risk for triad. All 347 NCAA Division I universities were invited to participate in a phone or email survey study. From that sample, 257 universities participated, and the authors collected 287 PPE forms. Authors of the survey wanted to collect information regarding the PPE screening process and practices; such as, frequency, timing, location of screening, and credentials of the examiners. In addition, the PPE forms were collected and analyzed by the authors using 12 items constructed by the Female Athlete Triad Coalition for the primary screening of the triad (these items have not yet been validated for screening athletes). Researchers found that all of the universities require a PPE for incoming athletes, but only 83 universities (32%) require a PPE for returning athletes. Twelve universities (5%) completed a full PPE every 2 years. Only 11 (4%) universities were using the most recent edition of the PPE form (4th edition). Sixteen universities (6%) were using the 3rd edition released in 2005. The remaining 260 universities (90%) did not use either of these forms. Two-hundred and forty (94%) universities used a standardized PPE form, and the remaining 15 universities (6%) accepted any form brought in by the athlete’s primary care physician. The orthopedic portion of the screening was typically conducted by an orthopedic surgeon (42%). Only 25 (9%) universities had 9 or more of the 12 recommended items for screening the triad in their forms, 127 universities (44%) had 4 items or less, and 63 if the universities (22%) had only 1 of 2 of the items. Only twenty (7%) of the PPE forms included a 72-hour nutritional assessment form. The most commonly omitted items on PPE come from the disordered eating category (e.g.,“does your weight affect the way you feel about yourself?”) . The 4th edition PPE form addresses 7 of the 12 items and the 3rd edition addresses 6 of the 12.

The triad consists of dysfunctional eating that can lead to dysfunctional menstruation and diminished bone health. Each of these concerns are addressed by the 12-items that are recommended for screening the triad on the PPE forms (8 disordered eating questions, 3 dysfunctional menstruation questions, and 1 bone health question); however, it is important to note that these items have not been well tested yet. Many of the universities do not follow up on return athlete, and those who do typically only require medical history updates reviewed by their athletic trainer. In these situations, only updates from athletes that the athletic trainer deems as “red flags” end up completing a full PPE. This may allow athletes who are at risk for developing the triad after their freshman year to be overlooked. In addition, to potentially missing high-risk return athletes, many forms were missing criteria that may be important for evaluating risk of the triad. Over half of the PPE forms did not ask about a history on disordered eating. Though the 12-item questionnaire may not be validated it may be a quick and easy to complete and help raise a flag for more thorough evaluations. Researchers suggest that the PPE forms currently being utilized by NCAA Division I universities may not be effectively screening for the Female Athlete Triad. Improved preparticiaption screening for the triad may lead to more frequent identification of athletes who are at risk and in need of further evaluation. Should there be a gender specific PPE form to correspond specifically to gender specific medical conditions?

Written by: Jane McDevitt MS, ATC, CSCS
Reviewed by: Jeffrey Driban

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Mencias T, Noon M, & Hoch AZ (2012). Female athlete triad screening in national collegiate athletic association division I athletes: is the preparticipation evaluation form effective? Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 22 (2), 122-5 PMID: 22266742