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Protecting the stars of tomorrow: do international cardiovascular preparticipation screening policies account for the paediatric athlete? A systematic review and quality appraisal
  1. Nathan R Riding1,2,
  2. Dan-Mihai Dorobantu3,4,5,
  3. Craig A Williams3,
  4. Graham Stuart5,6,
  5. Peter Fritsch7,
  6. Mathew G Wilson2,8,
  7. Elias Mossialos9,
  8. Guido Pieles2,8
  1. 1Bristol Medical School, University of Bristol, Bristol, UK
  2. 2Institute of Sport and Exercise Health (ISEH), University College London, London, UK
  3. 3Children’s Health and Exercise Research Centre, University of Exeter, Exeter, UK
  4. 4Population Health Sciences, University of Bristol, Bristol, UK
  5. 5Congenital Heart Unit, Bristol Royal Hospital for Children and Heart Institute, Bristol, UK
  6. 6National Institute for Health Research Cardiovascular Biomedical Research Centre, Bristol Heart Institute, Bristol, UK
  7. 7Paediatric cardiology Graz, Graz, Austria
  8. 8Athlete Health and Performance Research Centre and the Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  9. 9Department of Health Policy, London School of Economics, London, UK
  1. Correspondence to Dr Guido Pieles, Sports Medicine Department, Aspetar, Doha 122104, Qatar; guido.pieles{at}


Objective (1) Identify and review current policies for the cardiovascular screening of athletes to assess their applicability to the paediatric population and (2) evaluate the quality of these policy documents using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool.

Design Systematic review and quality appraisal of policy documents.

Data sources A systematic search of PubMed, MEDLINE, Scopus, Web of Science, SportDiscus and CINAHL.

Eligibility criteria for selecting studies An article was included if it was a policy/position statement/guideline/consensus or recommendation paper relating to athletes and cardiovascular preparticipation screening.

Results and summary Of the 1630 articles screened, 13 met the inclusion criteria. Relevance to paediatric athletes was found to be high in 3 (23%), moderate in 6 (46%) and low in 4 (31%), and only 2 provide tailored guidance for the athlete aged 12–18 years. A median 5 related citations per policy investigated solely paediatric athletes, with study designs most commonly being retrospective (72%). AGREEII overall quality scores ranged from 25% to 92%, with a median of 75%. The lowest scoring domains were rigour of development; (median 32%) stakeholder involvement (median 47%) and Applicability (median 52%).

Conclusion Cardiac screening policies for athletes predominantly focus on adults, with few providing specific recommendations for paediatric athletes. The overall quality of the policies was moderate, with more recent documents scoring higher. Future research is needed in paediatric athletes to inform and develop cardiac screening guidelines, to improve the cardiac care of youth athletes.

  • Athletes
  • Cardiology
  • Pediatrics
  • Adolescent
  • Heart

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  • Twitter @Nathan_Riding, @ag_stuart

  • Contributors The review was conceptualised by NRR and GP, with NRR DMD and GP contributing to the design. NRR applied the search strategy. NRR, DMD and GP applied the selection criteria, performed the data extraction and the guideline assessment. NRR and DMD analysed the data. NRR and DMD drafted the manuscript. All authors contributed to data interpretation and critically revised the manuscript. The corresponding author confirmed that all authors met authorship criteria.

  • 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.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.