Medical screening of athletes abroad

In 1971 it became Italian law that every athlete wishing to participate in competitive sports was required to undergo an annual…

In 1971 it became Italian law that every athlete wishing to participate in competitive sports was required to undergo an annual medical screening assessment.

This law was introduced to safeguard the health of all those practicing sport both at both competitive and non-competitive levels. The Italian medical screening programme includes a medical history, medical examination, urine testing, resting Electrocardiogram (ECG is an electrical tracing of the heart), exercise test, lung function tests and more recently an Echocardiogram (an ultra sound scan of the heart). At present about five million people undergo medical screening each year in Italy. One Italian study, which compared sudden deaths of young athletes (who were screened) with sudden deaths in non-athletes (who were not screened) from 1979 to 1996, has shown that screening detected 22 athletes with a diagnosis of Hypertrophic Cardiomyopathy. These 22 athletes were disqualified from participation in sport and none of this group died in the follow up period (3 to 13 years). There were sixteen deaths from Hypertrophic Cardiomyopathy in the unscreened non-athletic group during this time period.

In the United States Pre-participation Medical Evaluations have been done annually since the 1970¹s in High School and University athletes. They are an insurance requirement for clearance to participate in sport. Traditionally in the United States this annual medical involves taking a medical history and carrying out a medical examination and urine testing.

Recent studies suggest that this level of screening is not adequate. Dr Barry J. Maron analysed the medical files of 158 sudden athlete deaths that occurred in trained athletes throughout the United States from 1985 through to 1995. In this study 158 athletes died; 24 (15%) from non-heart related causes, 134 (85%) from heart-related causes. He found that the medical history and physical examination (no ECG or Echocardiogram was carried out) aroused suspicion of heart disease in only 3% of these athletes. 48 cardiovascular deaths (of the 134 cardiovascular deaths) were caused by Hypertrophic Cardiomyopathy and the screening protocol used (medical history and medical exam only) detected just one athlete with Hypertrophic Cardiomyopathy out of the 48 who died from this condition.

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In Indianapolis in 1992, 2,997 athletes were screened with a medical history, medical examination and Echocardiogram (ultrasound scan of the heart). Of the 64 athletes who were found to have structural heart

abnormalities detected on Echocardiogram, 40% of these had symptoms detected in the medical history and only 14% had abnormal findings in the cardiovascular part of the medical examination.

These studies suggest that to detect lethal heart abnormalities, the major cause of sudden athlete death in sport, the medical history and physical examination alone are not sensitive enough. Specific heart tests such as an ECG (an electrical tracing of the heart) and Echocardiogram (an ultrasound scan of the heart) should be included.

In 1998 the International Carding Scheme was set up by the National Coaching & Training Centre, funded by the Sports Council, to provide sports science and medical support to elite Irish athletes. The International Carding Scheme provides funded support for 250 of our top national athletes from 24 different sports including under-age junior athletes and members of the Olympic Team. The purpose of the International Carding Scheme is to provide expertise for these athletes from professionals working in Sports Medicine, Sports Physiotherapy, Exercise Physiology, Sports Psychology, Sports Nutrition and Biomechanics.

Annual Medical Screening of Carded athletes is an integral part of the International Carding Scheme and includes the following:

Detailed Medical History - to detect any past or current problems including any symptoms of heart disease, lung disease and including a family history

Musculoskeletal examination - by a Chartered Physiotherapist to detect any musculoskeletal conditions that predispose to injury or impair performance.

Medical Assessment - including urine testing, by a Sports Physician to assess any musculoskeletal problems, to assess general health, and to detect any underlying previously undiagnosed medical condition that might be life threatening or disabling or that might limit safe participation in sport.

Laboratory assessment:

- ECG (electrical tracing of the heart) and Echocardiogram (ultrasound scan

of the heart): To assess for any potentially lethal heart abnormalities.

- Blood tests: to assess for anaemia.

- Lung function test: to assess for asthma.

In practical terms this involves over 14 pairs of screeners (Sports Medicine Physicians and Chartered Physiotherapists) regionally and abroad as well as cardiac and pulmonary laboratory testing of athletes in Dublin (Mater Private Hospital), Limerick (Mid-Western Regional Hospital, Limerick) and Cork (Bons Secours Hospital).