July 29, 2025European Journal of Preventive Cardiology4 citations
View Full PaperPre-participation screening in competitive athletes in Italy: an analysis of real-world practice from a large database
Structured PICO
What are the outcomes, diagnostic yields, and resource utilization of pre-participation screening across different age groups of competitive athletes?
P
Population
61,731 competitive athletes (68.8% males) undergoing 111,062 pre-participation screenings (PPS). Subgroups included young (≤18 years, 47.4%), adult (19-34 years, 31.3%), and master (≥35 years, 20.8%) athletes.
I
Intervention
Pre-participation screening (PPS)
O
Outcome
Outcomes and resource utilization of pre-participation screening (including clearance rates, need for further investigations, prevalence of cardiac diagnoses, and costs)
Pre-participation screening in competitive athletes demonstrates a low overall rate of cardiac diagnoses that increases significantly with age, though there is considerable variability among physicians in interpreting abnormal ECGs.
Abstract
AIMS: To evaluate outcomes and resource utilization of preparticipation screening (PPS) in a cohort of young (≤18 years), adult (19-34 years), and master (≥35 years) competitive athletes. METHOD AND RESULTS: Retrospective analysis of structured clinical records of consecutive PPS collected in the years 2018-2024, by 30 sports physicians across 26 sports medicine centres.The study included 111.062 PPS performed in 61.731 competitive athletes (68.8% males): 47.4% were young, 31.3% were adult, and 20.8% were master athletes. Overall, 102.646 (92.4%) PPS were cleared for competitive sports activity after a normal first-line investigation while 8.416 (7.6%) required one or further investigations: 5.0%, 6.5% and 15.0% in the three age subgroups respectively (p=0.001). Finally, 378 (0.34%) PPS reported a disease or a condition at risk. The prevalence of cardiac diagnoses increased progressively from 0.06%, to 0.12%, and to 1.19% in the three age subgroups respectively (p=0.001). The abnormal ECGs rate per physician prompting second-line investigation ranged from 0% to 7.1% (median 1.5%, IQR 0.7% - 2.1%). The average cost per PPS of first and second-line investigations was €60, €62 and €107 for the 3 subgroups respectively. Costs for third-line tests and consultations were not considered. CONCLUSIONS: The prevalence of abnormal findings rose progressively with age, especially in master athletes. Sport physicians showed considerable differences in defining abnormal ECGs.