Results

All U-20 teams (100%) confirmed to have performed the PCMA in their players prior to the competition and seven FAs (43.8%) submitted the forms to FIFA Medical Office. For 14 U-17 teams (87.5%), the completed PCMA forms were submitted to the FIFA Medical Office. The PCMAs of one U-17 team were missing since the team physician claimed to have not received the respective information. One African FA had performed the PCMA of their U-20 players and stated thereafter not to have the financial means to perform PCMA in their U-17 team. All (except one) teams who submitted the forms used the FIFA PCMA form. In total, 147 PCMA forms of U-20 and 294 of U-17 players were received and analysed.

For African, Asian and Central/South American FAs, the team physician usually completed all sections, supervised and coordinated examinations by consultants (eg, cardiologists) and confirmed the eligibility to play themselves. Data were complete and presented in separate organised files per player and original data and reports (ECG and echocardiography) were provided with resulting excellent quality of data (particularly for U-17 teams). European and North American teams usually had several physicians from different institutions completing parts of the forms and signing the summary assessment. This resulted in highly variable completeness, presentation and quality of data. One European FA did not submit the FIFA PCMA form but submitted numerous different assessment forms, and for some players only the eligibility to play statement signed by a sports physician.

Personal and family history was completed for all players with no player reported to have any symptoms or signs of underlying disease. One African player reported what was understood as SCD in her father and was therefore submitted to follow-up. All players had normal physical cardiological examinations with a few systolic murmurs reported.

All teams had performed an ECG in their players (for one European team, the ECG performance could not be verified as the section was not completed). Twelve teams (57.1%) provided the original ECG strips, others the automatic or the cardiologist's report instead or in addition. Six teams omitted completing the measurements when they provided strips or reports. Most frequently reported findings (n = 17; 3.9%) were incomplete right bundle branch blocks (RBBBs) and early repolarisation patterns. Two players had signs of ventricular hypertrophy on ECG; however, this is only based on voltage criteria, and one player each had signs of interspersed junctional rhythm or atrial extrasystoles. All four players had an additional echocardiography, in two players ventricular hypertrophy was confirmed by the cardiologist with no further pathological findings and cardiological follow-up recommended.

Six (85.7%) U-20 and eight (57.1%) U-17 teams who submitted their forms had performed an echocardiography on all players. In addition, three (21.4%) U-17 teams had performed echocardiography only when indicated by abnormal findings in history, clinical examination or ECG. One African team performed echocardiography in all U-20 players but only where indicated in five U-17 players. The offer by FIFA to perform an echocardiography at the venue was only accepted by one of the teams who had not performed it prior to the competition at home; the others felt it interfered with their preparation schedule. One team refused because the cardiologist was a man.

Echocardiographic measurements were not always fully completed. Mostly, right ventricular and atrial as well as diastolic measurements were omitted. The majority of abnormal findings were mild-to-moderate regurgitation of the mitral, tricuspidal or pulmonary valve. Distribution and evaluation of these findings differed considerably: While no such finding was reported from other teams of the same confederation, the cardiologist of one U-17 reported eight pulmonary and one tricuspidal valve insufficiencies (and recommended all for follow-up without any further comment), and the cardiologist of one U-20 team considered the echocardiography as abnormal in eight players with regurgitation but recommended no follow-up. In addition, three U-17 players were reported to have signs of left ventricular hypertrophy, one player a thickened mitral valve and one player the surgical closure of an atrioseptal defect.

The summarising statements were duly completed in 64.3% of the U-17 teams and 85.7% of the U-20 teams. One team submitted an incomplete assessment of all players, and another team of 12 of their 21 players. Twelve (4.1%) U-17 and five (3.4%) U-20 players had no summarising assessment completed by the team physician. Nevertheless, declaration of eligibility was completed on all forms and all players were declared as eligible to play.