gms | German Medical Science

Sports medicine is a multidisciplinary clinical science that deals with the medical care of exercising people which includes diagnosis, treatment, prevention and rehabilitation of injuries or illness related to participation in sport. Thus, sports medicine embraces different areas of interest with particular regard for cardiology, orthopaedics, traumatology and internal medicine. Moreover, sports medicine gives a significant contribution in the area of prevention, not only of the sport-related accidents (musculoskeletal injuries, acute cardiac events and sudden cardiac death) but also of the chronic disorders caused by the sedentary life style of the contemporary time. Over the last five decades the need for sports medicine among European countries has been growing and pre-participation screening (PPS) programs has been implemented in many countries. Italy has been the first one to introduce a national health care program for athletes. According to the current Italian legislation, competitive athletes must undergo a yearly PPS including clinical evaluation (medical history and physical examination), 12 –lead ECG, urine analysis and pulmonary function test, to obtain a medical certification for sports eligibility. This kind of screening allow to detect some acute or chronic conditions that may cause of temporary or permanent disqualification from training and competition. Even if a broad spectrum of disease involving all organs and apparatus would be recognized, the leading causes of athletes’disqualification are represented by cardiovascular abnormalities which may represent a risk for sudden cardiac death (SCD), the most of which may be identify on this kind of screening. In 2005 the European Society of Cardiology (ESC) assessed a consensus statement for a common European protocol for the cardiovascular pre-participation screening of young competitive athletes for prevention of SCD. The ESC document stated that an effective cardiovascular screening must include a complete personal and family history, physical examination and 12-lead ECG, according to the Italian model, also following “The Lausanne Recommendation” issued by the International Olympic Committee (IOC) in 2004. The ESC proposal mainly derives from the observation of the long-standing experience of Italy where this screening modality for competitive athletes has been implementing since 1982 and has shown to be really effective by reducing of 90% the incidence of sports-related SCD. The screening protocol proposed by the ESC differs from that recommended by the American Heart Association (AHA) and currently applied in the U.S.A., based only on medical history and physical examination but not on 12-lead ECG that is considered a not cost-effective test in a large population of athletes due to its low specificity. In its document the ESC stated that the screening recommended by the AHA has a “limited power to detect potentially lethal cardiovascular abnormalities in young athletes” and that “the addition of 12-lead ECG has the potential to enhance the sensitivity of the screening process for detection of cardiovascular disease with risk of sudden death”. The recently published recommendations for the correct interpretation of the 12-lead ECG in athletes by the ESC group (2010) would result in increasing the ECG specificity (principally by distinguishing the physiological training-related ECG patterns from the potentially pathological, training-unrelated ECG abnormalities) as well as in lowering the global costs of the screening by reducing useless additional cardiac tests.