Pre-race self-reported medical conditions and allergies in 133 641 Comrades ultramarathon (90km) runners - SAFER XXIII

Abstract

Objectives: To determine the prevalence of self-reported pre-race chronic medical conditions and allergies in ultramarathon race entrants and to explore if these are associated with an increased risk of race-day medical encounters (MEs).Methods: Data from two voluntary open-ended pre-race medical screening questions (Q1history of allergies; Q2 -history of chronic medical conditions/prescription medication use) were collected in 133 641 Comrades Marathon race entrants (2014)(2015)(2016)(2017)(2018)(2019). Race-day ME data collected prospectively over 6 years are reported as incidence (per 1000 starters) and incidence ratios (IR: 95%CI's).Results: Pre-race medical screening questions identified race entrants with a history of chronic medical conditions and/or prescription medication use (6.9%) and allergies (7.4%).The % entrants with risk factors for cardiovascular disease (CVD) was 30% and being older (>45years) and male (27.5%) were the most frequent CVD risk factors. 0.3% of entrants reported existing CVD. The overall incidence of MEs was 20/1000 race starters. MEs were significantly higher in race entrants reporting a "yes" to Q1 (allergies) (IR=1.3; 1.1-1.5) (p=0.014) or Q2 (chronic medical conditions and/or prescription medication use) (IR=1.3; 1.1-1.5) (p=0.0006). Conclusions:Voluntary completion of two open-ended questions identified chronic medical conditions and/or prescription medication use in 6.9% and allergies in 7.4% of ultramarathon race entrants. This is lower than that reported for other races that implemented compulsory completion of a more comprehensive pre-screening questionnaire. Despite potential underreporting, a pre-race self-reported history of chronic medical conditions and allergies was associated with a higher risk of race-day MEs.

A comparison of two pre‐race medical screening tools in 5771 running race entrants—SAFER XXVIII

“…However, no scientific evidence supports the use of two screening questions to identify runners at risk for MEs on race day. We recently showed that the positive responses to these questions are predictive of MEs on race day, but that the voluntary completion of two open‐ended questions was considerably lower than that reported for other races that implemented compulsory completion of a more comprehensive pre‐screening questionnaire 23 . Currently, it is unknown to what extent the information from the abbreviated tool (two open‐ended medical questions) during the race entry process compares to a full and comprehensive pre‐race medical screening questionnaire.…”

“…Another medical doctor independently checked a subset of the responses for reliability. This coding process and reliability have previously been described in detail 23 …”

“…This coding process and reliability have previously been described in detail. 23 2.4.2 | Full detailed online medical screening tool (FULL)…”

“… 2 , 7 , 15 , 17 , 18 , 19 , 20 , 21 These guidelines were used as a framework to develop a comprehensive pre‐race medical screening and educational intervention tool for race entrants to identify risk factors for cardiovascular disease (CVD), symptoms of CVD, known CVD, and other chronic diseases. The full pre‐race medical screening tool is predictive of MEs, 15 , 22 , 23 can be used to risk stratify entrants and advise race entrants on medical clearance, 4 and includes disease‐specific educational intervention programmes for participants. This pre‐race medical screening and educational intervention tool has been shown in another event to significantly reduce serious/life‐threatening MEs.…”

“…We recently showed that the positive responses to these questions are predictive of MEs on race day, but that the voluntary completion of two open‐ended questions was considerably lower than that reported for other races that implemented compulsory completion of a more comprehensive pre‐screening questionnaire. 23 Currently, it is unknown to what extent the information from the abbreviated tool (two open‐ended medical questions) during the race entry process compares to a full and comprehensive pre‐race medical screening questionnaire. It has also been shown that MEs are reduced if comprehensive pre‐race screening was performed and an educational intervention is implemented in “very high risk” and “high risk” athletes.…”