To screen or not to screen, that is the question.
adapted from Hamlet, William Shakespeare (1564–1616)
Sports medicine clinicians commonly perform standardised health evaluations of athletes and many different organisations around the world require that athletes undergo a pre-participation evaluation to be allowed to participate in sport. However, organisations rarely provide guidance regarding the content of the required evaluation and the effectiveness of the approach in reducing the risk of injury, illness or sudden death in athletes remains controversial.
There are many different templates available, such as the Fédération Internationale de Football Association (FIFA) pre-competition medical assessment (PCMA),1 the International Olympic Committee periodic health examination (PHE)2 and the American Academy of Paediatrics pre-participation physical evaluation (PPE).3 It should be emphasised, however, that these are designed for different target groups and there is no one universal template that suits all situations.
In order to avoid any confusion in terminology in this chapter, we use the term ‘periodic medical assessment’ (PMA) to refer to the standardised medical assessment of athletes, without being specific to any group’s recommended template.
The development of a template for the PMA of an athlete, whether elite or recreational, requires careful planning, and gives an opportunity for all of the members of the sports medicine team and coaching staff to work in collaboration. Establishing the optimum template for each situation can be achieved by considering the following questions in turn.
Why perform the medical assessment?
Who is being assessed?
When and where should the assessment be performed, and by whom?
What should be included in the assessment?
Are there any other issues to consider?
WHY PERFORM THE MEDICAL ASSESSMENT?
The first step in planning a PMA template is to determine why you are performing the medical assessment. The primary goal of the PMA is to make participation in sport safer, but there are a number of other valid reasons for wanting to perform a PMA such as assessing the status of known injuries and illnesses, screening for risk factors, reviewing medications and supplements, baseline testing, athlete education and establishing rapport with athletes.
Identification of medical conditions that contraindicate participation in sport
There are some medical conditions that may contraindicate participation in certain sports or recreational activities; for example, uncontrolled epilepsy in motor racing, cycling or swimming; or human immunodeficiency virus (HIV) infection in an amateur boxer. In many cases, such as asthma in a scuba diver, the medical condition is not an absolute contraindication and athletic participation should be decided on a case-by-case basis. It is therefore important that the medical professional performing the PMA understands the physical and mental demands of the sport in question, as well as its regulations. Table 46.1 shows examples of medical conditions that warrant special attention or contraindicate participation in certain sports.