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Do not throw the baby out with the bathwater; screening can identify meaningful risk factors for sports injuries
  1. Evert Verhagen1,2,
  2. Nicol van Dyk3,4,
  3. Nicholas Clark5,
  4. Ian Shrier6
  1. 1 Amsterdam Collaboration on Health and Safety in Sports and Department of Public and Occupational Health, Amsterdam Movement Science, VU University Medical Center, Amsterdam, The Netherlands
  2. 2 UCT/MRC Research Unit for Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  3. 3 Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  4. 4 Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
  5. 5 Knee Injury Control and Clinical Advancement (KICCA) Research Group, School of Sport, Health and Applied Science, St Mary’s University, London, UK
  6. 6 Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
  1. Correspondence to Professor Evert Verhagen, Department of Public and Occupational Health, VU University Medical Center, Amsterdam 1081 BT, The Netherlands; e.verhagen{at}

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Norway’s Professor Roald Bahr recently highlighted that screening does not predict which athlete will sustain an injury.1 Some interpreted this to mean screening is useless for injury prevention. However, screening remains essential in our efforts to protect athletes’ health. To extend what has been a robust discussion, we argue how screening can be important for an individual athlete, and offer potential reasons why and how individual screening tests still lack clinical utility.

Positive predictive value and the prevention paradox

Previous injury is a well-established injury risk factor. Figure 1 shows data on ACL (re)injuries from Krosshaug et al.2 Applying a traditional (predictive) diagnostic test on these data yields unimpressive results; a positive predictive value of only 29%, with most injuries occurring in previously uninjured athletes. If effective interventions target only previously injured athletes, it would be withheld from the majority of athletes who could benefit. Consequently, we agree with Bahr,1 that all athletes receive effective interventions.

Figure 1

The relationship between unilateral ACL injuries and ACL reinjuries in a multiseason prospective cohort study in female football and handball players. (Based on original data from Krosshaug et al.2

But consider another perspective on the same risk factor ‘previous injury’. Regardless of the low predictive value, previous injury is …

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  • Contributors EV conceptualised the manuscript. All authors contributed in writing of the editorial.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.