Pre-Participation Musculoskeletal and Cardiac Screening of Male Athletes in the United Arab Emirates

Translational medicine @ UniSa 04/2014; 9:43-49.
Source: PubMed


This study presents the results of pre-participation musculoskeletal and cardiac screening using the Lausanne recommendations, which include a personal and family history, physical examination and electrocardiography. Cross sectional study using the Lausanne screenings and the European Society of Cardiology (ESC) recommendations carried out at Al-Ahli club in Dubai, United Arab Emirates. 230 male athletes participating in organised sports were included. Exclusion criteria were those under 14 or over 35 years old, females and athletes with established cardiovascular disease. Primary outcome are the results of Lausanne screening with outline of the negative, positive and false positive results and number needed to screen. Secondary outcomes include the results of musculoskeletal and neurological screening. A total of 174 (76%) athletes had a negative screening result. Fifty-four athletes (23%) underwent additional testing. Forty-seven athletes (20.4%) had false positive screening results. Seven athletes (3%) had a positive screening result and four athletes (2%) were restricted from sport. The number of athletes needed to screen to detect one lethal cardiovascular condition was 33 athletes.
The Lausanne recommendations are well suited for the United Arab Emirates. The number needed to screen to detect one athlete with serious cardiovascular disease is acceptable at 33.

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Available from: Nicola Maffulli, Aug 31, 2014
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    • "[. -.] . [. -.] STUDY(YEAR) COMBINED Hevia 2009 Alattar 2014 Fudge 2014 Snoek 2013 Menagoflio 2014 Bessem 2009 Magalski 2011 Fuller 1997 Anderson 2014 Price 2014 Baggish 2010 Deligiannis 2014 Assanelli 2012 Wilson 2011 Wilson 2008 0.0 1.0 SPECIFICITY "
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    ABSTRACT: Background: The optimal cardiovascular preparticipation screen is debated. The purpose of this study was to perform a systematic review/meta-analysis of evidence comparing screening strategies. Methods: PRIMSA guidelines were followed. Electronic databases were searched from January 1996 to November 2014 for articles examining the efficacy of screening with history and physical exam (PE) based on the American Heart Association (AHA) or similar recommendations and electrocardiogram (ECG). Pooled data was analyzed for sensitivity, specificity, false positive rates and positive and negative likelihood ratios. Secondary outcomes included rate of potentially lethal cardiovascular conditions detected with screening and the etiology of pathology discovered. Results: Fifteen articles reporting on 47,137 athletes were reviewed. After meta-analysis the sensitivity and specificity of ECG was 94%/93%, history 20%/94%, and PE 9%/97%. The overall false positive rate of ECG (6%) was less than that of history (8%), or physical exam (10%). Positive likelihood ratios were ECG 14.8, history 3.22 and PE 2.93 and negative likelihood ratios were ECG 0.055, history 0.85, and PE 0.93. There were a total of 160 potentially lethal cardiovascular conditions detected for a rate of 0.3% or 1 in 294. The most common pathology was Wolff-Parkinson-White (67, 42%), Long QT Syndrome (18, 11%), hypertrophic cardiomyopathy (18, 11%), dilated cardiomyopathy (11, 7%), coronary artery disease or myocardial ischemia (9, 6%) and arrhythmogenic right ventricular cardiomyopathy (4, 3%). Conclusions: The most effective strategy for screening for cardiovascular disease in athletes is ECG. It is 5 times more sensitive than history, 10 times more sensitive than physical exam, has higher positive likelihood ratio, lower negative likelihood ratio and a lower false positive rate. 12-lead ECG interpreted using modern criteria should be considered best practice in screening for cardiovascular disease in athletes while the use of history and physical alone as a screening tool should be reevaluated.
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