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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.
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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