Pre-participation evaluation of recreational and competitive athletes – A systematic review of guidelines and consensus statements

Abstract Objective: Pre-participation evaluation (PPE) aims to support safe participation in sports. The goal of this systematic review was to aggregate evidence- and consensus-based recommendations for the PPE of recreational or competitive athletes as preparation for developing a German guideline on this subject. Methods: Five databases, including MEDLINE, were searched in August 2022. Searches on the websites of relevant guideline organisations and specialty medical associations were also performed, complemented by citation screening. We included guidelines/consensus statements with recommendations for PPE of adult recreational athletes or competitive athletes of any age, both without chronic illness. We extracted and synthesised data in a structured manner and appraised quality using selected domains of the AGREE-II tool. Results: From the 6611 records found, we included 35 documents. Overall, the quality of the included documents was low. Seven documents (20%) made recommendations on the entire PPE process, while the remainder focussed on cardiovascular screening (16/35, 45.7%) or other topics. We extracted 305 recommendations. Of these, 11.8% (36/305) applied to recreational athletes, while the remaining 88.2% (269/305) applied to athletes in organised or competitive sports. A total of 12.8% (39/305) of recommendations were directly linked to evidence from primary studies. Conclusion: Many recommendations exist for PPE, but only a few are evidence based. The lack of primary studies evaluating the effects of screening on health outcomes may have led to this lack of evidence-based guidelines and contributed to poor rigour in guideline development. Future guidelines/consensus statements require a more robust evidence base, and reporting should improve. Registration: PROSPERO CRD42022355112