Pre-participation screening for competitive athletes

Pre-participation screening for athletes engaging in competitive sport

• GPs are increasingly asked to complete medicals for sporting events that enable patients to participate in sport
  
  
• although screening is not mandatory by law in the UK, it has become an increasing requirement for some events
  
  
• used appropriately, screening can detect causes of cardiovascular complications (even Sudden Cardiac Death (SCD)) during sport
  
  
• some feel that the cost of widespread screening to detect such abnormalities is prohibitive
  
  
• the level of screening undertaken varies hugely from country to country and from sport to sport. In Italy, a good medical history, physical examination and 12 lead ECG are compulsory by law for participants in competitive sport, with the possibility of echo if indicated
  
  
• Corrado et al (1) have published a consensus statement on pre-participation screening for athletes engaging in competitive sport
  
  
• intensive or prolonged training produces physiological changes that produce a wider range of normal in athletes
  
  • this can lead to difficulties for a doctor caring for these patients due to difficulty differentiating what is normal in athletes, from what is potentially pathological
  • it can also cause problems for athletes who may receive an inappropriate diagnosis leading to unnecessary investigations and possible withdrawal from the event until clarification of the diagnosis can be sought
  • if further investigations are performed it establishes 'normal' baseline levels for the athlete if new symptoms occur at a later time

Contributors:

• Dr Andrew Murray, Dr Duncan Goodall
  • Marathon Medical Services
• Prof Hillis
  • Professor of Cardiology and Exercise Medicine, University of Glasgow

Reference:

• 1) Corrado D, Pelliccia A, Bjørnstad HH, Vanhees L, Biffi A, Borjesson M, Panhuyzen-Goedkoop N, Deligiannis A, Solberg E, Dugmore D, Mellwig KP, Assanelli D, Delise P, van-Buuren F, Anastasakis A, Heidbuchel H, Hoffmann E, Fagard R, Priori SG, Basso C, Arbustini E, Blomstrom-Lundqvist C, McKenna WJ, and Thiene G. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 2005 Mar; 26(5) 516-24. doi:10.1093/eurheartj/ehi108 pmid:15689345