To screen or not to screen: commentary and review on screening laboratory tests in elite athletes

Evaluation of a Vitamin D Screening and Treatment Protocol Using a Seasonal Calculator in Athletes

ABSTRACT

Vitamin D is important in musculoskeletal health, and low serum vitamin D concentration is common in athletes. This study implemented a vitamin D screening and supplementation protocol in a cohort of National Collegiate Athletic Association Division I athletes using summer 25-hydroxyvitamin D concentration and a seasonal variation calculator to achieve sufficient vitamin D concentration year-round. After implementation of the Vitamin D Protocol, there was a nonsignificant difference in athletes with sufficient winter vitamin D concentrations (72.6%) compared with summer vitamin D concentrations (66.1%) (P = 0.40). The Seasonal Variation Calculator predicted winter vitamin D concentrations (8 ± 18 ng·mL-1) higher than actual winter vitamin D concentrations (P < 0.01). While most athletes (78%) believed vitamin D was important for athletic performance, athlete compliance to the Vitamin D Protocol was inconsistent. In the future, adjustment of vitamin D screening and supplementation protocols may help athletes achieve sufficient vitamin D status year-round.

Assessing the utility of yearly pre-season laboratory screening for athletes on a major professional sports team

OBJECTIVES

Professional athletes undergo annual pre-season laboratory screening, although clinical evidence supporting the practice is limited and no uniform set of guidelines on pre-season laboratory screening exists. The aim of this study was to assess the clinical value of annual pre-season laboratory screening tests for a major professional sports team over multiple years.

DESIGN

Retrospective chart review.

METHODS

A retrospective analysis was performed of all laboratory results as well as screening ECGs for a single major professional sports team over a 9-year timeframe (2009-2017).

RESULTS

The data show that 10.01% of initial screening test results were abnormal and 40.32% of abnormal tests resulted in additional testing. Overall, only 0.35% of initial tests resulted in a clinically significant outcome. Non-US born players showed a significantly higher average rate of abnormal tests/year compared to US-born players (p-value 0.006), but there was no difference in clinically significant outcomes. There was no relationship between athlete age and laboratory screening outcomes.

CONCLUSIONS

In our study population, yearly pre-season laboratory screening of professional athletes did not yield substantial clinically significant outcomes and would not be warranted under normal clinical standards. Future best practice guidelines should combine research concerning effects of family medical history, race, gender, country of origin, and type of sport on athlete health when creating recommendations for which pre-season laboratory screenings may be pertinent even with evidence of little utility.

Iron Deficiency and Anemia among Collegiate Athletes: A Retrospective Chart Review

PURPOSE

To describe the prevalence of anemia among incoming female college athletes and to characterize the results and expenses of iron-related testing at one National Collegiate Athletic Association Division I institution.

METHODS

In this retrospective medical record review, hemoglobin (Hgb) and ferritin laboratory values were obtained for student-athletes at a single institution, 2002 to 2014. Laboratories were collected either as part of the preparticipation examination (PPE) for female athletes, routine screening for cross-country athletes, or as needed for medical evaluation. Anemia was defined as Hgb < 11.6 g·dL for females and < 13.6 g·dL for male athletes. Iron deficiency was defined as Fer < 20 ng·mL for both sexes.

RESULTS

A total of 5674 laboratory draws were obtained for 2749 individuals (56% female) from 25 different teams. The prevalence of low Hgb among female athletes at PPE was 5.7% (95% confidence interval, 4.4%-6.9%). At PPE, the incidence of anemia was not significantly higher for any sport when compared with the group mean. Ferritin and Hgb were collected together in approximately one third of all blood draws from females (n = 1059) and one sixth of blood draws from males (n = 411). For female athletes, 2.2% indicated iron deficiency anemia and 30.9% indicated iron deficiency without anemia. For male athletes, 1.2% indicated iron deficiency anemia and 2.9% indicated iron deficiency without anemia. The median cost of iron testing exceeded US $20,000 annually for the institution.

CONCLUSIONS

One in 20 incoming female athletes was identified with anemia at the PPE. Given the costs of testing, screening practices at each institution should be thoughtfully selected and routinely reassessed.