Medical Screening. What is Medical Screening. What is Successful Screening
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1 Medical Screening What is it? Why do we do it? Components screening Examples (squads, organisations) Aspects of screening CVS, asthma, medications, vaccinations Blood tests, female athletes Outcomes What is Medical Screening Seeking pertinent medical information Detecting injury Acting on and resolve injury Optimising health and performance Medical, Vaccinations Psychological Nutritional Physiological Biomechanical What is Successful Screening Planning Preparation Site, who, what, how long Realistic durations for outcomes Specific outcomes Reviews of the process and outcomes 1
2 Why do we do Medical Screening? Medical problems in 10-30% Athletes 30-78% adolescents only regular health examination 7-18% athletes have a problem to discuss with doctor Injury prevalence varies sports Community Injury Rates WA 50% were injured in season 701 Injuries in 1391 participants 470 more than 1 injury Most injuries in the first 4 weeks Injury prevalence: Football (AFL) 48% Field Hockey 28% Netball`16% Basketball 10% Stevenson et al BJSM 2000;34: AFL Injury Survey All AFL injuries, prevalence, incidence, recurrence Label axes? Key small / difficult colours Incidence Severity Recurrence rate Prevalence Orchard J, Seward H. AFL injury report
3 Outcomes of Screening Smith (1998) 2937 athletes - medical problems and injuries in 10% Only 1-3% acted on detected problems! Need Follow-up!! Questionnaires Goldberg: 63% -78% medical and musculoskeletal injuries identified prior to screening Questionnaire - 80% chance of identifying problems for upcoming screening Accuracy? Gabbe - athletes (AFL) remembered 100% of their injuries 80% remembered number and sites 3
4 QAS Athlete Screening Results Area Medical Diagnoses Medication New Injury in last 12/12* Second Injury last 12/12* Screening Prevalence Frequency 31% 22% 67% 22% 29% * Same site, same pathology Medical Problems QAS Athletes (424) Number of athletes Blood clot Psoriasis Rubella Depression Urinary tract infec... Anaemia Mononucleosis Cyst or tumour Ear infection Eczema Repeat sinus infection Chicken Pox Oral herpes Injury & Screening What injury knowledge assists screening? 4
5 What we know about injury 1980 Lysens Injury is predicable 1990 Many injury risk factors identified Intrinsic risk factors Extrinsic risk factors Olsen Proved injury reduction Injury reduced by 50% ACL injury decreased form 10 to 3 Injury prevention 1. Identification of risk factors (focus on modifiable) 1.Historical ph, age sport, time of year 2.Physical strength (static / dynamic), gender 3.Injury links (literature based) WA study - back injury increases risk LL injury QAS increased risk of back pain with calf, hamstring, second injuries Injury present at the end of previous season increases risk next season Injuries with Proven Reduction Programs Ankle Injuries Anterior Cruciate Injuries Overuse Injuries Hamstring Injuries Lower Limb Injuries (stress fractures) 5
6 Long Term Sequelae of ACL Injury Radiological OA prevalence Osteoarthrosis (% of patients) ACL reconstruction Non-operative Surgery does osteoarthritis! Follow-up (years) Myklebust & Bahr. Br J Sports Med 39:127-31, 2005 Components of Medical Screening Goals Risk Management Practicalities History Examination Follow-up Formal Goals of Medical Screening 1. Fit to compete safely - Medico-legal 2. Improve total medical care of athletes 3. Decrease and prevent injury 4. Meet and greet athletes, coaches, management 6
7 Risk Management Screening Are clear protocols established? Screening questionnaire Medical examination Vicarious liability define responsibility if screening not done Questionnaire not done Examination not done Who is responsible for follow-up? Is this best practice? Literature compliant, medical management What athlete behaviours or components of screening have been excluded and what risk? Components of Medical Screen History (critical) Completed before with summary (ideal) Medical, vaccinations, injury, psychology, nutrition Examination Rooms, station format, camps Systems to be examined CVS, Respiratory (referral) Others as required e.g. Marfan's (basketball) Musculo skeletal screen Orthopaedic exam short or long Detect, resolve and reduce injury Supplementary investigations (Follow-up) Spirometry, ECG, Bone density Simon Locke's Squad Medical Problems Asthma 25% 25% Heat Stress 50% 33% Medical Issue 17% 17% 7
8 Simon Locke s Injuries Injury Primary Injury Second Injury Site % 14% Back % 0% Back Special Areas Cardiovascular screening Female athletes Blood tests Asthma Medications, Vaccinations Future Sudden Cardiac Death (SCD) Screening American Heart Association (1996) Questions on exercise related symptoms Actions based on positive response Am J Card Editorial (Dec 2003) HCM, suspicious history leads to ECHO England - History leads to specialist cardiac centre Italy, European Society of Cardiology (2005) Annual screening all athletes (NNT analyses) history, ECG, ECHO, Limited Ex. test 8
9 Sudden Cardiac Death and Sport Prevalence 1/200,000 Young athletes increased risk of SCD RR =2.5 SCD tends to be exercise related SCD attributable to cardiovascular pathology Corrado et al J Am Coll Cardiol 2003 Sudden Cardiac Death in Australia* Causes of Death Unascertained Coronary a. Dis.(30-34) HCM, LV hypertrophy Myocarditis (viral) Congenital Heart Dis. Other Total Number (%) 60 (31%) 46 (24%) 29 (15%) 23 (12%) 14 (7%) 21 (11%) 193 (100%) *Doolan MJA Feb 2004 QAS SCD Screening all athletes Symptoms Exercise related Number (%) Dizziness Syncope Chest Pain Dyspnoea Positive FH SD (<50) 66 (35.7%) 30 (12.1%) 24 (9.7%) 41 (16.6%) 11 (4.5%) 9
10 Follow-up 2 nd Year Athletes (symptoms) Investigations Clinical Examination ECG only ECHO only ECG and ECHO Other Number Questions Do screening questions identify the at risk athlete? Is screening for HCM, ARRVD realistic? What role for clinical examination, ECG? Currently no Australian strategy that will identify all athletes at risk for SCD Female athletes Specific problems for screenings: 1) Amenorrhoea prevalence 10-15% Eating disorders Bone density 2) Specific injury risks ACL Back pain and specific weaknesses, Hip Extension 3) Others CJSM Vol 14,
11 Are screening blood tests useful in elite athletes? Results Males (75) Hb abnormalities dilutional only No abnormalities of clinical significance Females (90) 45.5% abnormalities in Hb, ferritin Iron storage problems, no deficiency of erythropoiesis Recommendations, Elite Sport Males on entry, clinical grounds Females entry, regular intervals (?6/12) 11
12 Asthma and QAS athletes Asthma Type All QAS athletes (424) Current asthma Prevalence ( %) 13% Dr Diagnosed asthma prevalence% 26% QAS athletes yrs (213)* 15% 28% Qld reference yrs (211)* 11% 29% *NS *Current Asthma = Dr Diagnosed asthma +ever had asthma +symptoms in last 12 months +-medication for asthma Current Asthma and Medication QAS (424) National Asthma Report No Medication 28%? B Agonists Total 60% 59% Inhaled Steroids 40% 28% Other Medication 5% 1-2% Medication Athletes on medication Medication needing notification Athletes Last Notified NSO >12mths Athletes not notified NSO Athlete No Prevalence *QAS medical screening data,
13 QAS reported vaccination rates 01/02 Athlete Vaccination Rates (%) Vaccination TETANUS MEASLES POLIO MUMPS HEPATITIS B HEPATITIS A % Athletes Vaccinated Reported Heat Stress in QAS Prevalence of heat stress 15% Increases risk of: Next episode Increased fatigue Decreased performance with weight loss Sports with weight categories Expected Outcomes of Screening Before screening Knowledge of injury / illness patterns in sport Plan process and organise review After screening Knowledge of your athletes Education of athletes / coaches (preventing / managing injuries) Important injuries to deal with Individual basis Squad basis Who does the coordinating / follow-up? 13
14 Future Medical Screening Internet based attached to databases Questionnaire Individual reports Squad reports (planning) Recommendations for injury reduction Examination findings Summary Information BEFORE screening Know YOUR sport (Injury patterns) Arrange FOLLOW-UP 14
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Vassar College 124 Raymond Avenue Box 17 Poughkeepsie New York Please contact us at for any questions/concerns.
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Summer Pre-College Programs Dear Summer Pre-College Student and Family, Welcome to Marist College! Please review the attached Health Forms. Students will be informed of health and emergency information