Pre-participation screening in competitive athletes in Italy: an analysis of real-world practice from a large...

This study aims to evaluate outcomes and resource utilization of pre-participation screening (PPS) in a cohort of young (≤18 years), adult (19-34 years), and master (≥35 years) competitive athletes.

This study is a retrospective analysis of structured clinical records of consecutive PPS collected in the years 2018-24, 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 8416 (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 electrocardiograms (ECGs) rate per physician prompting second-line investigation ranged from 0 to 7.1% (median 1.5%, interquartile range 0.7-2.1%). The average cost per PPS of first- and second-line investigations was €60, €62, and €107 for the three subgroups, respectively. Costs for third-line tests and consultations were not considered.

The prevalence of abnormal findings rose progressively with age, especially in master athletes. Sport physicians showed considerable differences in defining abnormal ECGs.