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February 17, 1999

Cardiovascular Screening of High School Athletes—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(7):607-608. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-7-jbk0217

In Reply: Drs Gunn and Friedman raise the issue of incorporating selected biomedical screening tests into the PPE, specifically testing for C trachomatis genital tract infections. What they are suggesting is expanding the acquisition of information from the history and physical examination to include laboratory testing for preventable, treatable premorbid conditions. Their suggestion raises several points for discussion.

What are appropriate limits for a PPE? While these are quite easy to define in relation to readiness for participation in sport, what determines the cut point for inclusion of tests unrelated to sport participation but important for disease treatment and prevention? Is the mandate for the PPE to improve health, to determine readiness for sport, or both? Why stop at testing for Chlamydia? What about testing for cholesterol levels in large football linemen or asymptomatic iron deficiency in runners or spondylolysis in gymnasts and divers? Are the appropriate limits of a PPE set by risk ratios and cost-effectiveness?