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The Italian preparticipation evaluation programme: diagnostic yield, rate of disqualification and cost analysis
  1. Teresina Vessella1,
  2. Alessandro Zorzi2,
  3. Laura Merlo1,
  4. Cinzia Pegoraro1,
  5. Flaviano Giorgiano1,
  6. Michele Trevisanato1,
  7. Mirella Viel1,
  8. Pietro Formentini1,
  9. Domenico Corrado2,
  10. Patrizio Sarto1
  1. 1 Center for Sports Medicine and Exercise Prescription, Treviso, Italy
  2. 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
  1. Correspondence to Dr Alessandro Zorzi, Department of Cardiac, Thoracic and Vascular Sciences, Universita degli Studi di Padova, Padova 35100, Italy; alessandro.zorzi{at}


Introduction Italian law mandates that every competitive athlete must undergo annual preparticipation evaluation (PPE) to identify cardiovascular (CV) diseases that pose a risk of sudden death (SD) during sport and other conditions that may threaten the athlete’s health. We investigated the diagnostic yield, rate of disqualification and costs of our PPE.

Methods We included 5910 consecutive apparently healthy athletes (61% males, mean age 15±4 years) who underwent annual PPE performed by a sports medicine specialist. The PPE included history, physical examination, weight, height and blood pressure measurement, test of visual acuity, spirometry, urine chemistry, resting 12-lead ECG and exercise testing with ECG monitoring. In cases of abnormal findings, we carried out second-line investigations.

Results During a 12-month study period, 5.326 (90.2%) athletes were cleared for competition after a normal first-line evaluation and 584 (9.8%) underwent one or more further examinations. Of those, 88 (1.5%) were diagnosed to have a CV disease (including 18 (0.3%) at-risk of SD) and 31 (0.5%) had a non-CV diagnosis. A total of 32 (0.5%) athletes were temporarily (n=15) or permanently (n=17) disqualified from competitive sports. The average cost per athlete was €79, which consisted of €64 (80%) for first-line evaluations and €15 (20%) for additional investigations.

Conclusion PPE according to the Italian model identified a range of diseases in 2.0% of apparently healthy athletes at an average cost of €79.

  • athletes
  • cost–benefit analysis
  • preparticipation screening
  • sports medicine
  • sudden death

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  • TV and AZ are joint first authors.

  • TV and AZ contributed equally.

  • Contributors All authors have significantly contributed in at least two of the following points: study design, data collection, data analysis, manuscript drafting and critical revision of the manuscript.

  • Funding This research received fundings from the preventive healthcare directorate of the Veneto region of Italy (Direzione Prevenzione, sicurezza alimentare e veterinaria, Regione Veneto, Rio Novo - Dorsoduro 3493, Venezia, Italy)

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Ethical committee of the Treviso province (No 643). Consent form was not required as data are completely anonymised.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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